Intensivmedizinisches Management der akuten valvulär bedingten Herzinsuffizienz

Acute cardiac insufficiency as a result of cardiac valvular disease presents a special challenge for intensive medicine. It can often be treated only after gaining exact knowledge of prevailing hemodynamic conditions. Decompensation of chronically existing heart disease, or recently developing valvular disease, can represent underlying factors. Rapid diagnosis is critical, since particular hemodynamic constellations can exist in valvular-related cardiac insufficiency which require treatment different from standard therapy for cardiac insufficiency under other circumstances. Whereas the usual therapy principles pertaining to reduction of preload and afterload are otherwise extensively applied in cases of heart failure, different strategies (e.g., frequency attenuation) are required for stenotic disorders. Hemodynamic monitoring by means of a flow-directed catheter facilitates effective control of the therapy. For patients who cannot be stabilized by medication, prompt heart surgery or interventional catheter therapy (the latter in selected cases) is critical.