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Lungenerkrankungen und Herzfunktion

Pulmonary diseases and heart function

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Zusammenfassung

Die gravierendste Auswirkung von Lungenerkrankungen auf die Herzfunktion ist die Belastung des rechten Herzventrikels durch eine pulmonale Hypertonie mit Ausbildung eines Cor pulmonale. Dieses ist charakterisiert durch eine Hypertrophie und/oder Dilatation der rechten Herzkammer aufgrund einer primären Beeinträchtigung der Lungenfunktion und/oder Lungenstruktur. Die wichtigsten Pathomechanismen der pulmonalen Hypertonieentstehung sind Gefäßobliteration, mechanische Läsionen, primäre vaskuläre und extravaskuläre Inflammation sowie hypoxische Vasokonstriktion. Die chronisch obstruktive Lungenerkrankung (COPD) stellt die häufigste Ursache eines chronischen Cor pulmonale dar. Eine weitere häufige Ursache ist das obstruktive Schlafapnoesyndrom, insbesondere dann, wenn es in Kombination mit einer COPD auftritt. Hier beträgt die Prävalenz des Cor pulmonale bis zu 80%. Die Entwicklung eines chronischen Cor pulmonale stellt einen entscheidenden negativen prognostischen Faktor dar. So leben nur etwa 30% der Patienten mit COPD und Cor pulmonale länger als 5 Jahre. Nur die frühzeitige Erkennung der potenziell zum Cor pulmonale führenden Atmungsstörung und deren konsequente medikamentöse und apparative Therapie kann die Prognose dieser Patienten verbessern. Darüber hinaus können Lungenerkrankungen auch Beeinträchtigungen der Pumpfunktion des linken Herzens oder aber Herzrhythmusstörungen hervorrufen. Lungenerkrankungen können somit eine Auswirkung auf die Funktion sowohl des rechten wie auch des linken Herzens haben.

Abstract

The most severe cardiac sequel to lung disease is the load on the right ventricle due to pulmonary hypertension with the development of a cor pulmonale. This is characterized by hypertrophy and/or dilatation of the right ventricle because of a primary impairment of lung function and/or lung structure. The most important pathomechanisms for the development of pulmonary hypertension are vessel obliteration, mechanical lesions, primary vascular or extra-vascular inflammation and hypoxic vasoconstriction. Chronic obstructive pulmonary diesease (COPD) is one of the most important reasons for chronic cor pulmonale. A further very common reason is obstructive sleep apnea syndrome, especially if combined with a COPD. In this case, the prevalence of cor pulmonale can reach 80%. The development of a chronic cor pulmonale is the most striking negative prognostic factor for these patients. Only 30% of COPD patients with cor pulmonale survive longer than 5 years, and only early detection of the disturbances to respiration which might potentially lead to cor pulmonale and their subsequent therapy are able to improve the patient’s prognosis. Furthermore, pulmonary diseases may also have an impact on the left heart side in terms of an impairment of left heart function or by inducing severe arrhytmias. Thus, lung diseases may have both a significant impact on right and left heart performance.

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Authors and Affiliations

  1. Zentrum für Innere Medizin,Schwerpunkt Pneumologie, Allergologie, Schlaf- und Beatmungsmedizin, Kliniken St. Atonius, Akademisches Lehrkrankenhaus der Universität Düsseldorf, 42109, Vogelsangstr. 106, Wuppertal, Deutschland

    K. Rasche & A. Kutscha

  2. Berufsgenossenschaftliche Klinken Bergmannsheil, Medizinische Klinik III (Pneumologie, Allergologie, Schlaf- und Beatmungsmedizin), Universitätsklinikum Bochum, Deutschland, Bochum

    M. Orth & H. W. Duchna

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  1. K. Rasche
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  4. H. W. Duchna
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Correspondence to K. Rasche.

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Rasche, K., Orth, M., Kutscha, A. et al. Lungenerkrankungen und Herzfunktion. Internist 48, 276–283 (2007). https://doi.org/10.1007/s00108-006-1763-z

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