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Aktuelle Neurologie 2017; 44(02): 89-98
DOI: 10.1055/s-0043-101374
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Herzrhythmusstörungen nach Schlaganfall

Cardiac Arrhythmia Following Stroke
Bernd Kallmünzer
1   Neurologische Universitätsklinik Erlangen, Erlangen
,
Stefan Schwab
1   Neurologische Universitätsklinik Erlangen, Erlangen
› Author Affiliations
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Publication History

Publication Date:
11 April 2017 (online)

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Zusammenfassung

Jeder vierte Patient leidet in der Akutphase des Schlaganfalles unter klinisch relevanten Herzrhythmusstörungen, die den Krankheitsverlauf durch hämodynamische Instabilität verkomplizieren, die körperliche Leistungsfähigkeit des Patienten während der Neurorehabilitation limitieren und das Rezidivrisiko des Schlaganfalles erhöhen können. Auf der Stroke Unit erreicht eine gezielte Analyse der kontinuierlichen EKG-Ableitung in Form einer „Rhythmusvisite“ nahezu eine Verdoppelung der Detektionsrate von paroxysmalem Vorhofflimmern im Vergleich zum konventionellen Monitoring. Nach unauffälliger stationärer Diagnostik kommen bei begründetem Verdacht auf unerkannte kardiale Arrhythmien innovative Techniken zum ambulanten Langzeitmonitoring zum Einsatz. Therapeutisch steht für den Neurologen neben dem Notfallmanagement der Arrhythmie insbesondere die differenzierte antithrombotische Therapie zur Sekundärprophylaxe des Schlaganfalles im Vordergrund. Dabei ergeben sich besondere Fragestellungen und klinische Herausforderungen.

Abstract

1 in 4 patients with acute stroke suffers from clinically relevant cardiac arrhythmia that may complicate the clinical course by hemodynamic instability, limit the success of rehabilitation care and increase the risk for stroke recurrence. A structured analysis of the continuous ECG recordings at the stroke unit can double the detection rate of paroxysmal atrial fibrillation compared to conventional monitoring. In case of suspected cardiac arrhythmia, ambulatory long-term rhythm monitoring is available for patients with stroke of unknown cause. Apart from the emergency management of arrhythmia, different aspects of the antithrombotic treatment for secondary prevention are of major therapeutic relevance and represent clinical challenges for the neurologist.

Schlüsselwörter

Schlaganfall - Arrhythmien - Embolie - Vorhofflimmern

Keywords

stroke - arrhythmia - embolism - atrial fibrillation
 

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