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Empfehlung zur Herzinsuffizienz

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Recommendations for the treatment of heart failure

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  • Arzneimitteltherapie
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An Erratum to this article was published on 09 November 2013

Zusammenfassung

Die Therapie der chronischen systolischen Herzinsuffizienz folgt einem Stufenschema in Abhängigkeit von der linksventrikulären Funktion und der Symptomatik der Patienten. Bei symptomatischen Patienten mit hochgradig eingeschränkter linksventrikulärer Funktion (Ejektionsfraktion ≤ 30 %) kommen die folgenden Medikamente bzw. Verfahren zum Einsatz: 1. Angiotensin-Converting-Enzym(ACE)-Hemmer (Angiotensin-Rezeptorblocker als Reservesubstanzen); 2. β-Blocker; 3. Aldosteron-Antagonisten; 4. Diuretika bei Vorhandensein von Stauungszeichen und -symptomen; 5. Digitalis, insbesondere zur Frequenzkontrolle bei gleichzeitigem Vorhofflimmern; 6. Ivabradin bei Sinusrhythmus und einer Herzfrequenz ≥ 75/min; 7. der interne Kardioverter-Defibrillator (ICD); 8. bei Linksschenkelblock und/oder verbreitertem QRS-Komplex die kardiale Resynchronisationstherapie (in der Regel kombiniert mit einem internen Kardioverter-Defibrillator); 9. die intravenöse Eisensubstitution bei Eisenmangel. 10. Körperliches Training sollte einen wesentlichen Bestandteil der Therapie herzinsuffizienter Patienten darstellen.

Abstract

Treatment escalation of chronic systolic heart failure depends on left ventricular function and symptoms of the patients. In symptomatic patients with severely reduced left ventricular function (ejection fraction ≤ 30 %), the following therapeutic approaches are recommended: (1) angiotensin-converting enzyme (ACE) inhibitors (angiotensin receptor blocker in case of ACE inhibitor intolerance); (2) β-blockers; (3) mineralocorticoid receptor antagonists; (4) diuretics in case of signs and symptoms of congestion; (5) digitalis, in particular in patients with atrial fibrillation; (6) ivabradine in patients with sinus rhythm and a heart rate ≥ 75/min; (7) an implantable cardioverter defibrillator (ICD); (8) in case of left bundle branch block or wide QRS complex, cardiac resynchronization therapy (CRT; in most cases in combination with an implantable cardioverter defibrillator); (9) intravenous administration of iron in case of iron deficiency; (10) exercise training should be strongly recommended in patients with stable heart failure.

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Einhaltung der ethischen Richtlinien

Interessenkonflikt. G. Hasenfuß: Vortragshonorare und Beratungstätigkeit: Servier; Vortragshonorare: CVRx und Impulse Dynamics; Beratungstätigkeit: Novartis und Circulite; Fördermittel: Deutsche Forschungsgemeinschaft, Bundesministerium für Bildung und Forschung. F. Edelmann: Beratungstätigkeit: BG Medicine, CVRx, Novartis, Servier; Vortragshonorare/Veranstaltungen/Mitarbeit an klinischen Studien: Berlin-Chemie, Novartis, Pfizer, Servier, Bayer, Gilead, CVRx, Relypsa, Sanofi-Aventis, AstraZeneca, BG Medicine, Abbott, Boehringer Ingelheim, Medtronic, Biotronik; Fördermittel: Deutsche Herzstiftung, Deutsche Forschungsgemeinschaft, Publikationszuschuss der Universität Göttingen. R. Wachter: Seit 2003 Forschungs-, Beratungs- oder Vortragstätigkeiten für Bayer, Berlin-Chemie, Boehringer Ingelheim, Boston Scientific, CVRx, Gilead, Johnson & Johnson, Medtronic, Novartis, Pfizer, Relypsa, Sanofi, Servier; Fördermittel vom Bundesministerium für Bildung und Forschung (Kompetenznetz Herzinsuffizienz und DZHK) und von Boehringer Ingelheim. Das vorliegende Manuskript enthält keine Originaldaten aus Studien an Menschen oder Tieren.

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  1. Klinik für Kardiologie und Pneumologie, Herzzentrum, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland

    G. Hasenfuß, F. Edelmann & R. Wachter

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  1. G. Hasenfuß
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Correspondence to G. Hasenfuß.

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Hasenfuß, G., Edelmann, F. & Wachter, R. Empfehlung zur Herzinsuffizienz. Internist 54, 1141–1151 (2013). https://doi.org/10.1007/s00108-013-3312-x

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