Intensivmedizinische Behandlung der Herzinsuffizienz im Kindesalter

Kernaussagen

• Bei neu aufgetretener Herzinsuffizienz muss vor einer längerfristigen medikamentösen Behandlung eine kausale Ursache behoben werden.

• Bei angeborenen Herzfehlern müssen individuelle pathophysiologische Besonderheiten beachtet werden:
  - bei Links-rechts-Shunt Vorsicht mit Sauerstoffgabe!
  - bei zyanotischer Krise und dynamischer infundibulärer Pulmonalstenose keine Katecholamine!

• Milrinon als Nachlastsenker und Inotropikum ist wirksam bei akuter Herzinsuffizienz und im Kindesalter erprobt.

• Bei schwerem akutem myokardialen Versagen Katecholamine mit Nachlastsenkern kombinieren, um das HZV zu steigern.

• Begleitumstände (Temperatur, Herzfrequenz, Rhythmus, Säure-Basen-Haushalt, Beatmung) optimieren.

• Nach der akuten Phase einschleichende Einstellung auf Herzinsuffizienztherapie (ACE-Hemmer, Diuretika, β-Blocker).

• Bei progredienter Herzinsuffizienz und Schock trotz aller Medikation mechanische Kreislaufunterstützung erwägen. Ist ein längerfristiger Bedarf abzusehen, ist das Berlin Heart EXCOR das System der Wahl.

Literatur

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