Kardiovaskuläre Symptome beim idiopathischen Parkinson-Syndrom

Zusammenfassung

Kardiovaskuläre Symptome treten bei fast allen Patienten mit einem Parkinson-Syndrom im klinischen Verlauf auf. Sie können in allen Phasen der Erkrankung beginnen und unterschiedliche Schweregrade aufweisen. Die Symptome sind häufig unspezifisch und nicht richtungweisend. Klinisch am bedeutendsten ist die orthostatische Hypotonie, die sich als anhaltender Blutdruckabfall über Minuten zeigt. Diagnostisch ist der Schellong-Test etabliert und sinnvoll. Die Therapie besteht aus konservativen Maßnahmen wie Stützstrümpfen. Medikamentöse Ansätze wie Midodrin sind nur bedingt hilfreich. Eine weitere wichtige klinische Auffälligkeit ist der fehlende Blutdruckabfall in der Nacht (non-dipper). Diagnostiziert wird dies mit einer 24-StundenBlutdruckmessung. Bei einer Blutdruckeinstellung ist diese klinische Besonderheit zu beachten. Die MIBG-Szintigrafie ist eine wichtige Untersuchung, mit der zwischen einem idiopathischen und einem atypischen Parkinson-Syndrom differenziert werden kann. Sie belegt darüber hinaus eine Mitbeteiligung des peripheren autonomen Nervensystems bei der Erkrankung.

Summary

Cardiovascular symptoms are observed in nearly all Parkinson patients during the clinical course of their disease. They may develop in any phase of the illness and exhibit varied degrees of severity. Symptoms are frequently unspecific and not conclusive. Orthostatic hypotension is the most significant clinical feature presenting in the form of blood pressure drops lasting for minutes. Schellong’s test is an established and practical diagnostic procedure. Treatment consists in conservative measures like elastic stockings. Medicinal approaches, by midodrine for instance, are of limited value only. Another clinically important aspect is the missing fall of blood pressure at night (non-dipper), which is diagnosed by prolonged ambulatory blood pressure monitoring over 24 hrs. This specific clinical aspect has to be kept in mind while working at blood pressure control. MIBG-scintiscan is paramount in this regard to be able to differentiate between idiopathic and atypical Parkinson’s syndrome. Moreover, it helps identifying involvement of the peripheral autonomic nervous systems in that disease.

Schlüsselwörter

Parkinson-Syndrom - Blutdruck - Herzfrequenz - non-dipper - orthostatische Hypotonie - MIBGSzintigrafie

Keywords

Parkinson’s disease - blood pressure - heart rate - non-dipper - orthostatic hypotension - MIBG-scintiscan

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