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Lungenembolie

Pulmonary embolism

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Der Pneumologe Aims and scope

Zusammenfassung

Lungenembolien sind relativ häufig, bleiben oft asymptomatisch, enden aber nicht selten fatal. Während die akute Lungenembolie das höchste Mortalitätsrisiko innerhalb der ersten Stunde nach dem Ereignis hat, dauert es bei der chronisch thromboembolischen pulmonalen Hypertonie oft viele Jahre, bis sich eine bedrohliche Rechtsherzinsuffizienz entwickelt. Obwohl beide Erkrankungen miteinander verwandt sind, weisen sie unterschiedliche pathologische Mechanismen auf und erfordern unterschiedliche diagnostische und therapeutische Maßnahmen. Bei klinischem Verdacht auf akute Lungenembolie hilft ein evidenzbasierter diagnostischer Algorithmus bei der Entscheidung, ob eine Antikoagulation eingeleitet werden muss oder mit akzeptablem Risiko darauf verzichtet werden kann. Bei vorhandener Embolie kann die Entscheidung für oder gegen eine Lysetherapie mithilfe eines evidenzbasierten therapeutischen Algorithmus getroffen werden. Risikofaktoren der Lungenembolie müssen gegen die der Lyse abgewogen werden. Biomarker wie BNP und TNT sowie die Echokardiographie gewinnen an Stellenwert. Wichtig ist die klinische Aufmerksamkeit, damit die Verdachtsdiagnose gestellt wird. Hinweisend sind nicht nur die Beschwerden, sondern auch die Risikokonstellation, die wissenschaftlich zunehmend Beachtung findet.

Abstract

Thromboembolic events are frequent and may remain asymptomatic but possess a considerable mortality risk. During the first hour, acute events pose the highest mortality risk, while chronic thromboembolic pulmonary hypertension often gradually develops over a period of many years before it leads to right heart failure. Although the two diseases are related, they involve different pathologic mechanisms and require different diagnostic and therapeutic management. In patients with suspected acute thromboembolism, an evidence-based diagnostic algorithm helps decide whether to begin anticoagulation treatment or to withhold it with a tolerable risk. In patients suffering an acute event, an evidence-based therapeutic algorithm helps decide whether thrombolysis should be considered. Echocardiography and biomarkers such as B-type natriuretic peptide (BNP) and troponin are becoming increasingly important. Clinical awareness of thromboembolic events is of the utmost importance. Not only the patients’ complaints but also the acknowledgement of risk factors are helpful and are attracting increasing scientific interest.

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  1. Klinische Abteilung für Pulmonologie, Medizinische Universität Graz, Auenbruggerplatz 20, 8036, Graz, Österreich

    H. Olschewski

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Olschewski, H. Lungenembolie. Pneumologe 5, 45–54 (2008). https://doi.org/10.1007/s10405-007-0188-2

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  • DOI: https://doi.org/10.1007/s10405-007-0188-2

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