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PriorLiving Schweiz: Angina pectoris

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Angina pectoris

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Angina pectoris

Als koronare Herzkrankheit (KHK) bezeichnet man die Unterversorgung des Herzmuskels mit Sauerstoff aufgrund einer Verengung der Herzkranzgefäße (Koronararterien). Der Erkrankung liegt fast immer eine Arteriosklerose (Arterienverkalkung) zugrunde.

Die Angina pectoris ist das häufigste Beschwerdebild, das durch die KHK verursacht wird. Bei Mehrbelastung des Herzens (körperliche Arbeit, Stress, üppige Mahlzeit, Fieber) kommt es zu Schmerzen, Enge- oder Druckgefühl im Brustkorb. Die Schmerzen sind in der Regel von kurzer Dauer (5-30 min) und können in den linken Arm oder den Hals ausstrahlen. Die Beschwerden können von Angst oder Atemnot begleitet sein.

Viele Betroffene leben jahrelang mit den wiederkehrenden Beschwerden einer Angina pectoris. Dennoch muss jede neu, bzw. in Ruhe auftretende oder sich verschlechternde Angina unbedingt sofort abgeklärt werden, da ein Herzinfarkt unmittelbar drohen kann oder bereits vorliegt. Durch spezielle Untersuchungen im Krankenhaus muss der Herzinfarkt, der eine ganz andere Therapie erfordert, rasch ausgeschlossen werden. Auch andere, teilweise schwere Erkrankungen, können in ihren Symptomen einer Angina pectoris sehr ähneln (z. B. Herzinfarkt).

Männer sind etwa dreimal häufiger als Frauen betroffen. Neben der Angina pectoris, unter der jeder zweite KHK-Patient leidet, kann die KHK auch Herzrhythmusstörungen und Herzmuskelschwäche (Herzinsuffizienz) verursachen. In 25% der Fälle bleibt die KHK „stumm“. Ohne jegliche Vorzeichen kann es dann zu einem Herzinfarkt kommen.

Diagnose einer Angina pectoris

 

Die Diagnosestellung einer koronaren Herzkrankheit erfolgt mit einem Belastungs-EKG: Während körperlicher Belastung (Fahrradfahren, Laufband) werden die Herzströme abgeleitet. Eine Minderversorgung von Teilen des Herzmuskels kann der Arzt an Veränderungen der Herzströme erkennen. Die Untersuchung mit einem Herzkatheter liefert genaue Information darüber, welches Herzkranzgefäß wie stark eingeengt ist, gleichzeitig kann eine vorhandene Herzschwäche eingeschätzt werden.

Die Diagnostik einer KHK umfasst auch die Suche nach ihren Risikofaktoren (siehe Vorbeugung). Hierzu zählt u. a. eine 24 Stunden-Blutdruckmessung und verschiedene Blutuntersuchungen.

Spezielle nuklearmedizinische Methoden (Messung von Herzfunktionen unter Einsatz radioaktiver Substanzen) werden bislang nur an größeren Zentren bei speziellen Fragestellungen oder unklaren Befunden durchgeführt.

Therapie

 

Die Therapie der KHK fußt auf drei Säulen:

  • medikamentöse Behandlung,
  • operative Verfahren
  • Ausschaltung von Risikofaktoren.

Ziel ist in jedem Fall die Beschwerdefreiheit des Patienten. Solange Angina pectoris-Anfälle auftreten, ist die Infarktgefahr nicht gebannt.

  • Medikamentöse Behandlung: Nitrate, Calciumkanalblocker und Betablocker erweitern die Herzkranzgefäße und/oder verringern den Sauerstoffbedarf des Herzens. Sie werden einzeln oder in Kombination eingesetzt. Zusätzlich gibt man niedrig dosiert Acetylsalicylsäure, um die Entstehung von Blutgerinnseln an den Gefäßengstellen zu verhindern.
  • Operative Verfahren: Es ist möglich, mit einem Herzkatheter in die Herzkranzgefäße vorzudringen, um dort die Engstelle(n) mittels eines Ballons an der Katheterspitze auszudehnen. Eine solche „Ballondilatation“ hat eine relativ geringe Komplikationsrate und eine zunächst hohe Erfolgsrate. Leider verengen sich bis zu 40% der so aufgedehnten Gefäße binnen 6 Monaten wieder. Im Rahmen einer (viel aufwendigeren) Bypass-Operation werden Gefäßstücke (meist aus einer Beinvene) an die Herzkranzgefäße genäht, um die Engstellen zu umgehen. Je nach Operationsverfahren muss mit einem Verschluss von etwa 10% bis 50% der Bypässe innerhalb von 10 Jahren gerechnet werden.
  • Ausschaltung von Risikofaktoren: Dies ist eine gemeinsame Aufgabe von Arzt und Patient.

 

Der KHK liegt eine Arteriosklerose (“Arterienverkalkung”) der Herzkranzgefäße zugrunde. Die Arteriosklerose entsteht vermutlich aufgrund eines fehlerhaften Zusammenspiels verschiedener Komponenten der Gefäßwände und des Blutes. Risikofaktoren hierfür sind neben genetischer Veranlagung insbesondere Bluthochdruck, Zuckerkrankheit, Zigarettenrauchen und bestimmte Fettstoffwechselstörungen. Durch das verengte Gefäß erreicht ohne körperliche Anstrengung noch genügend Blut den Herzmuskel. Bei Belastung können die verkalkten Gefäße jedoch dem erhöhten Sauerstoffbedarf des Herzens nicht mehr gerecht werden; es kommt zur Unterversorgung des Herzmuskels. Ein völliger Verschluss der Engstelle führt zum Absterben des Herzmuskels und somit zum Herzinfarkt.

Vorbeugende Massnahmen

 

In umfangreichen Studien wurden Risikofaktoren nachgewiesen, die die Wahrscheinlichkeit einer Arteriosklerose, und damit einer KHK, um ein mehrfaches erhöhen. Beim Vorhandensein mehrerer Faktoren addieren sich die Einzelrisiken:

Risikofaktoren 1. Ordnung sind:

  • Rauchen
  • Fettstoffwechselstörungen (v. a. Erhöhung des LDL-Cholesterins und Verminderung des HDL-Cholesterins)
  • Bluthochdruck
  • Diabetes mellitus (Zuckerkrankheit)

Die Krankheit können begünstigen:

  • fettreiche Ernährung
  • Übergewicht
  • Bewegungsmangel
  • Stress

Alle genannten Faktoren können durch eine geeignete Lebensführung oder medikamentöse Behandlung durch den behandelnden Arzt günstig beeinflusst werden. Der einzelne kann also durchaus sein Risiko, an der KHK und ihren Folgen zu erkranken, vermindern und auch nach Diagnosestellung den Verlauf günstig beeinflussen. Beispielsweise sinkt das Herzinfarktrisiko von dem Tag an, an dem das Zigarettenrauchen eingestellt wird, stetig!

 Die Informationen ersetzen nicht die fachliche Beratung durch einen Arzt oder Apotheker. Für konkrete und individuelle Fragen zur Therapie wenden Sie sich bitte an Ihren Arzt.

Quelle:www.medizin-netz.de