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Kardiogener Schock

Cardiogenic shock

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Zusammenfassung

Die klassische Ursache des kardiogenen Schocks ist der akute Myokardinfarkt. Der ischämische Verlust von kontraktiblem Myokard induziert ein komplexes Krankheitsbild, das zum globalen Pumpversagen führen kann und dann eine Letalität von mehr als 50% aufweist. Die Ursachen des kardiogenen Schocks sind, abgesehen von der akuten Myokardischämie, insgesamt vielfältig. Prognostisch entscheidend ist zielgerichtetes Handeln: zügige Diagnosestellung, Identifikation und Behandlung des auslösenden Ereignisses, Optimierung von Herzarbeit und Hämodynamik sowie die Behandlung sekundärer Folgen der kardialen Insuffizienz. Die Therapie der kardialen Erkrankung steht im Vordergrund und muss bei perioperativen Patienten mit dem chirurgischen Krankheitsbild individuell abgestimmt werden, v. a. im Hinblick auf Antikoagulation und Thrombozytenaggregationshemmung. Die hämodynamische Stabilisierung umfasst in erster Linie die medikamentöse Unterstützung der kardialen Pumpfunktion, die Kontrolle von Arrhythmien und die Korrektur des Flüssigkeitshaushalts. Prävention und intensivmedizinische Behandlung eines schockbedingten Endorganversagens sind für die erfolgreiche Behandlung entscheidend.

Abstract

Cardiogenic shock is most commonly a complication of acute myocardial infarction. The ischemic loss of functional myocardium triggers distinct cardiovascular responses which can deteriorate to global pump failure with a mortality rate of more than 50%. Causes of cardiogenic shock beyond myocardial ischemia are very diverse. Decisive management with rapid evaluation, identification of the underlying disease and urgent initiation of supportive measures as well as definitive therapy is of prognostic value. Causal treatment of the cardiac disease is crucial but has to be weighed against the specific surgical circumstances of perioperative patients, particularly concerning anticoagulation, platelet inhibition and bleeding risks. Hemodynamic stabilization is achieved by pharmacological support of myocardial function, control of arrhythmia and volume load. Prevention and intensive care of shock-related multiorgan failure is of pivotal importance in the successful management of cardiogenic shock.

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  1. Klinik für Anästhesie und Intensivtherapie, Universitätsklinik Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland

    S. Rasche

  2. Klinik für Kardiochirurgie, Herzzentrum Dresden, Dresden, Deutschland

    C. Georgi

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  1. S. Rasche
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  2. C. Georgi
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Correspondence to S. Rasche.

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Rasche, S., Georgi, C. Kardiogener Schock. Anaesthesist 61, 259–274 (2012). https://doi.org/10.1007/s00101-012-1986-4

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