Dyspnoe - Dyspnoe - MSD Manual Profi-Ausgabe (2024)

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mb-2 space-y-2 text-primary-500"> <div class="font-semibold">Table of Contents</div> <a class="list-item toc-h2" href="#toc-0">Pathophysiologie der Dyspnoe</a> <a class="list-item toc-h2" href="#toc-1">Ätiologie der Dyspnoe</a> <a class="list-item toc-h3" href="#toc-2"> Hinweis zur Ätiologie</a> <a class="list-item toc-h2" href="#toc-3">Beurteilung der Dyspnoe</a> <a class="list-item toc-h3" href="#toc-4"> Anamnese</a> <a class="list-item toc-h3" href="#toc-5"> Körperliche Untersuchung</a> <a class="list-item toc-h3" href="#toc-6"> Warnzeichen</a> <a class="list-item toc-h3" href="#toc-7">Interpretation der Befunde</a> <a class="list-item toc-h3" href="#toc-8"> Tests</a> <a class="list-item toc-h3" href="#toc-9"> Evaluationshinweis</a> <a class="list-item toc-h2" href="#toc-10">Behandlung der Dyspnoe</a> <a class="list-item toc-h3" href="#toc-11">Literatur zur Therapie</a> <a class="list-item toc-h2" href="#toc-12">Wichtige Punkte</a> </div> <div class="text-center my-2 sm:my-4 " > <ins class="adsbygoogle adsense h-ad3 " data-ad-client="ca-pub-3373908032421588" style="display:block" data-ad-format="auto" data-ad-slot="3352989513" data-full-width-responsive="true" data-adtest="off" > </ins> <script> (adsbygoogle = window.adsbygoogle || []).push({}); </script> </div> <article class="article-detail"> <section class="entry-content paragraph"><div><p><span> Dyspnoe bedeutet subjektive Atemnot. Die Atmung wird als unangenehm oder anstrengend empfunden. Sie wird von den Patienten in Abhängigkeit von der Ursache unterschiedlich erfahren und beschrieben.</span></p><section><h2 data-originaltitle=" Pathophysiologie" id="toc-0"><span><span>Pathophysiologie der Dyspnoe</span></span><span></span></h2><div><p><span> Obwohl Atemnot ist ein relativ häufiges Problem ist, wird die Pathophysiologie des unangenehmen Atmungsgefühls schlecht verstanden. Im Gegensatz zu anderen Arten von schädlichen Reizen, gibt es keine speziellen Rezeptoren für Dyspnoe (wenngleich die MRT-Studien ein paar spezifische Bereiche im Mittelhirn identifiziert haben, die die Wahrnehmung von Dyspnoe vermitteln können).</span></p><p><span>Die Empfindung der Dyspnoe resultiert wahrscheinlich aus einer komplexen Interaktion zwischen der Stimulation der Chemorezeptoren, mechanischen Anomalien der Atmung, Anomalien der Herzfunktion oder des venösen Rückflusses und der Wahrnehmung dieser Anomalien durch das zentrale Nervensystem. Einige Autoren haben das Ungleichgewicht zwischen neurologischer Stimulation und mechanischen Veränderungen in der Lunge und Brustwand als euromechanische Entkopplung beschrieben.</span></p></div></section><section><h2 data-originaltitle=" Ätiologie" id="toc-1"><span><span>Ätiologie der Dyspnoe</span></span><span></span></h2><div><p><span>Dyspnoe hat viele pulmonale, kardiale sowie andere Ursachen (</span><span><span><span>1</span></span></span><span>), die je nach Schweregrad des Auftretens variieren (siehe Tabellen </span><span><a target="_blank"><span>Ursachen der akuten Dyspnoe</span></a></span><span>, </span><span><a target="_blank"><span>Ursachen der subakuten Dyspnoe</span></a></span><span> und </span><span><a target="_blank"><span>Ursachen der chronischen Dyspnoe</span></a></span><span>).</span><div class="sm:flex sm:items-center sm:justify-center sm:flex-row sm:space-x-1 insert" style="margin-top:0; margin-bottom:0;"><ins class="adsbygoogle sm:w-1/2" style="display:block; text-align:center;" data-ad-layout="in-article" data-ad-format="fluid" data-full-width-responsive="true" data-ad-slot="3352989513" data-ad-client="ca-pub-3373908032421588" data-adtest="off"></ins><script>(adsbygoogle = window.adsbygoogle || []).push({});</script><ins class="adsbygoogle sm:w-1/2" style="display:block; text-align:center;" data-ad-layout="in-article" data-ad-format="fluid" data-full-width-responsive="true" data-ad-slot="3352989513" data-ad-client="ca-pub-3373908032421588" data-adtest="off"></ins><script>(adsbygoogle = window.adsbygoogle || []).push({});</script></div></p><p><span>Die </span><b><span>häufigsten</span></b><span> Ursachen sind:</span></p><ul><li><p><span><span><span>Asthma</span></span></span></p></li><li><p><span><span><span>COPD</span></span></span><span> (chronisch obstruktive Lungenerkrankung)</span></p></li><li><p><span><span><span>Herzinsuffizienz</span></span></span></p></li><li><p><span><span><span>Myokardischämie</span></span></span></p></li><li><p><span> Physikalische Dekonditionierung</span></p></li><li><p><span><span><span>Pneumonie</span></span></span></p></li></ul><p><span> Die häufigste Ursache der Dyspnoe bei Patienten mit chronischen Lungen-oder Herzerkrankungen ist</span></p><ul><li><p><span> Verschlimmerung ihrer Krankheit</span></p></li></ul><p><span> Jedoch können solche Patienten auch akut eine weitere Erkrankung entwickeln (z. B. kann ein Patient mit langjähriger Asthma einen Myokardinfarkt haben, ein Patient mit chronischer Herzinsuffizienz kann eine Pneumonie entwickeln).</span><div class="sm:flex sm:items-center sm:justify-center sm:flex-row sm:space-x-1 insert" style="margin-top:0; margin-bottom:0;"><ins class="adsbygoogle sm:w-1/2" style="display:block; text-align:center;" data-ad-layout="in-article" data-ad-format="fluid" data-full-width-responsive="true" data-ad-slot="3352989513" data-ad-client="ca-pub-3373908032421588" data-adtest="off"></ins><script>(adsbygoogle = window.adsbygoogle || []).push({});</script><ins class="adsbygoogle sm:w-1/2" style="display:block; text-align:center;" data-ad-layout="in-article" data-ad-format="fluid" data-full-width-responsive="true" data-ad-slot="3352989513" data-ad-client="ca-pub-3373908032421588" data-adtest="off"></ins><script>(adsbygoogle = window.adsbygoogle || []).push({});</script></div></p><div><div><div><div><p>Tabelle</p></div><div><div aria-expanded="false" tabindex="0"><p>Ursachen der akuten Dyspnoe*</p></div></div></div></div></div><div><div><div><div><p>Tabelle</p></div><div><div aria-expanded="false" tabindex="0"><p>Ursachen der Subakuten* Dyspnoe</p></div></div></div><div class="bg-primary-100 rounded-lg my-6 px-2 py-3 font-semibold insert" style="color: rgb(37, 99, 235)"><div class="text-common !leading-common ml-1 insert" style="margin-top: 0.2rem; margin-bottom: 0.2rem">See Also</div><a class="list-item toc-h2 py-1" style="border-bottom: none" href="https://fantasygameday.net/article/elevate-your-english-pronouncing-dyspnea-correctly/3543" target="_blank" rel="noopener">Elevate Your English: Pronouncing Dyspnea Correctly</a></div><div class="sm:flex sm:items-center sm:justify-center sm:flex-row sm:space-x-1 insert" style="margin-top:0; margin-bottom:0;"><ins class="adsbygoogle sm:w-1/2" style="display:block; text-align:center;" data-ad-layout="in-article" data-ad-format="fluid" data-full-width-responsive="true" data-ad-slot="3352989513" data-ad-client="ca-pub-3373908032421588" data-adtest="off"></ins><script>(adsbygoogle = window.adsbygoogle || []).push({});</script><ins class="adsbygoogle sm:w-1/2" style="display:block; text-align:center;" data-ad-layout="in-article" data-ad-format="fluid" data-full-width-responsive="true" data-ad-slot="3352989513" data-ad-client="ca-pub-3373908032421588" data-adtest="off"></ins><script>(adsbygoogle = window.adsbygoogle || []).push({});</script></div></div></div><div><div><div><div><p>Tabelle</p><div class="sm:flex sm:items-center sm:justify-center sm:flex-row sm:space-x-1 insert" style="margin-top:0; margin-bottom:0;"><ins class="adsbygoogle sm:w-1/2" style="display:block; text-align:center;" data-ad-layout="in-article" data-ad-format="fluid" data-full-width-responsive="true" data-ad-slot="3352989513" data-ad-client="ca-pub-3373908032421588" data-adtest="off"></ins><script>(adsbygoogle = window.adsbygoogle || []).push({});</script><ins class="adsbygoogle sm:w-1/2" style="display:block; text-align:center;" data-ad-layout="in-article" data-ad-format="fluid" data-full-width-responsive="true" data-ad-slot="3352989513" data-ad-client="ca-pub-3373908032421588" data-adtest="off"></ins><script>(adsbygoogle = window.adsbygoogle || []).push({});</script></div></div><div><div aria-expanded="false" tabindex="0"><p>Ursachen für chronische* Dyspnoe</p></div></div></div></div></div><section><span></span><h3 id="toc-2"><span></span><span><span> Hinweis zur Ätiologie</span></span></h3><div><ol><li><p><span>1. </span><a href="http://www.ncbi.nlm.nih.gov/pubmed/0002802893" rel="noopener nofollow" target="_blank">Pratter MR, Curley FJ, Dubois J, Irwin RS</a><span>: Cause and evaluation of chronic dyspnea in a pulmonary disease clinic. </span><i><span>Arch Intern Med</span></i><span> 149 (10): 2277–2282, 1989.</span></p></li></ol></div></section></div></section><section><h2 data-originaltitle=" Beurteilung" id="toc-3"><span><span>Beurteilung der Dyspnoe</span></span><span></span></h2><div><section><span></span><h3 id="toc-4"><span></span><span><span> Anamnese</span></span></h3><div><p><span> Die </span><b><span>Anamnese der jetzigen Krankheit</span></b><span> sollte die Dauer, zeitliches Auftreten (z. B. abrupt, schleichend) und auslösende oder verstärkende Faktoren (z. B. Allergenkontakt, Kälte, Anstrengung, Rückenlage) abdecken. Der Schweregrad kann durch die Beurteilung des Aktivitätslevels, der erforderlich ist, um eine Dyspnoe zu verursachen (z. B. ist Dyspnoe in Ruhe ernster als Dyspnoe, die nur bei Treppensteigen auftritt) bestimmt werden. Ärzte sollten feststellen, inwieweit sich die Dyspnoe vom üblichen Zustand des Patienten geändert hat.</span></p><p><span> Bei der </span><b><span>Untersuchung der Körpersysteme</span></b><span> sollte nach Symptomen der möglichen Ursachen gesucht werden, darunter Thoraxschmerz oder -druck (</span><span><span><span>Lungenembolie</span></span></span><span>, Myokardischämie, </span><span><span><span>Pneumonie</span></span></span><span>); abhängigen Ödemen, Orthopnoe und paroxysmale nächtliche Dyspnoe (</span><span><span><span>Herzinsuffizienz</span></span></span><span>); Fieber, Schüttelfrost, Husten und Sputumproduktion (Pneumonie); schwarzer, zäher Stuhl oder schwer verlaufende Menstruation (okkulte Blutungen, die möglicherweise </span><span><span><span>Anämie</span></span></span><span> verursachen) sowie Gewichtsverlust oder Nachtschweiß (Krebs oder chronische Infektion der Lunge).</span><div class="sm:flex sm:items-center sm:justify-center sm:flex-row sm:space-x-1 insert" style="margin-top:0; margin-bottom:0;"><ins class="adsbygoogle sm:w-1/2" style="display:block; text-align:center;" data-ad-layout="in-article" data-ad-format="fluid" data-full-width-responsive="true" data-ad-slot="3352989513" data-ad-client="ca-pub-3373908032421588" data-adtest="off"></ins><script>(adsbygoogle = window.adsbygoogle || []).push({});</script><ins class="adsbygoogle sm:w-1/2" style="display:block; text-align:center;" data-ad-layout="in-article" data-ad-format="fluid" data-full-width-responsive="true" data-ad-slot="3352989513" data-ad-client="ca-pub-3373908032421588" data-adtest="off"></ins><script>(adsbygoogle = window.adsbygoogle || []).push({});</script></div></p><p><span>Die </span><b><span>Anamnese</span></b><span> sollte bekannte Erkrankungen, die eine Dyspnoe verursachen, wie z. B. </span><span><span><span>Asthma</span></span></span><span>, </span><span><span><span>chronische obstruktive Lungenerkrankung</span></span></span><span> und Herzerkrankungen sowie Risikofaktoren für die verschiedenen Ursachen einschließen:</span></p><ul><li><p><span>Raucheranamnese – für Krebs, chronische obstruktive Lungenerkrankung, einige </span><span><span><span>interstitielle Lungenerkrankungen</span></span></span><span> und Herzerkrankungen</span></p></li><li><p><span> Familienanamnese, Bluthochdruck und hohe Cholesterinwerte–für die </span><span><span><span>koronare Herzkrankheit</span></span></span></p></li><li><p><span>Aktuelle Immobilisierung oder Operation, kürzliche Fernreisen, Krebs oder Risikofaktoren für oder Anzeichen von okkulten Krebs, frühere oder in der Familie vorkommende Gerinnungsstörungen, Schwangerschaft, Einnahme oraler Kontrazeptiva, Schmerzen in der Wade, geschwollene Beine und bekannte tiefe Venenthrombose–für </span><span><span><span>Lungenembolie</span></span></span></p></li></ul><p><span>Umwelt- und berufsbedingte Expositionen (z. B. </span><span><span><span>Gase</span></span></span><span>, </span><span><span><span>Rauch</span></span></span><span>, </span><span><span><span>Asbest</span></span></span><span>) sollten untersucht werden.</span></p></div></section><section><span></span><h3 id="toc-5"><span></span><span><span> Körperliche Untersuchung</span></span></h3><div><p><span> Die Vitalzeichen werden auf Fieber, Tachykardie und Tachypnoe untersucht.</span></p><p><span> Die Untersuchung konzentriert sich auf die Herz-Kreislauf- und Lungen-Systeme.</span></p><p><span> Es wird eine komplette Untersuchung der Lunge durchgeführt, darunter insbesondere der Umfang des Ein-und Ausstroms der Luft, Symmetrie der Atemgeräusche und das Vorhandensein von feuchten RG, Giemen, Stridor und Keuchen. Es sollte nach Zeichen der Konsolidierung (z. B. Ägophonie, Klopfschalldämpfung) gesucht werden. Die zervikalen, supraklavikulären und Inguinalbereiche sollten inspiziert und auf Lymphadenopathie palpiert werden.</span></p><p><span> Die Halsvenen sollten auf Aufdehnung inspiziert und die Beine sowie der präsakrale Bereich auf eingedellte Ödeme (beide deuten auf </span><span><span><span>Herzinsuffizienz</span></span></span><span> hin) palpiert werden.</span><div class="sm:flex sm:items-center sm:justify-center sm:flex-row sm:space-x-1 insert" style="margin-top:0; margin-bottom:0;"><ins class="adsbygoogle sm:w-1/2" style="display:block; text-align:center;" data-ad-layout="in-article" data-ad-format="fluid" data-full-width-responsive="true" data-ad-slot="3352989513" data-ad-client="ca-pub-3373908032421588" data-adtest="off"></ins><script>(adsbygoogle = window.adsbygoogle || []).push({});</script><ins class="adsbygoogle sm:w-1/2" style="display:block; text-align:center;" data-ad-layout="in-article" data-ad-format="fluid" data-full-width-responsive="true" data-ad-slot="3352989513" data-ad-client="ca-pub-3373908032421588" data-adtest="off"></ins><script>(adsbygoogle = window.adsbygoogle || []).push({});</script></div></p><p><span> Die Herztöne sollten abgehört und alle auftretenden zusätzlichen Herztöne, gedämpften Herztöne oder Geräusche vermerkt werden. Die Untersuchung auf </span><span><span><span>Pulsus paradoxus</span></span></span><span> (a </span><span><span>></span></span><span> 12-mmHg Abfall des systolischen RR während der Inspiration) kann durch Aufblasen der Blutdruckmanschette auf 20 mmHg über den systolischen Druck und dann langsames Ablassen bis das erste Korotkow-Geräusch nur beim Ausatmen zu hören ist, geschehen. Beim weiteren Entleeren der Manschette wird der Punkt, an dem das erste Korotkow-Geräusch sowohl während der Inspiration als auch der Exspiration zu hören ist, aufgezeichnet. Wenn die Differenz zwischen der ersten und der zweiten Messung </span><span><span>></span></span><span> 12 mmHg ist, liegt ein Pulsus paradoxus vor.</span></p><p><span> Die Bindehaut sollte auf Blässe untersucht werden.</span></p></div></section><section><span></span><h3 id="toc-6"><span></span><span><span> Warnzeichen</span></span></h3><div><p><span> Die folgenden Ergebnisse sind von besonderer Bedeutung:</span></p><ul><li><p><span> Dyspnoe in Ruhe während der Untersuchung</span></p></li><li><p><span> Bewusstseinstrübung oder Unruhe oder Verwirrung</span></p></li><li><p><span> Einsatz der Atemhilfsmuskulatur und schlechte Luftexkursion</span></p></li><li><p><span> Thoraxschmerz</span></p></li><li><p><span> Feuchte RG</span></p></li><li><p><span> Gewichtsverlust</span><div class="sm:flex sm:items-center sm:justify-center sm:flex-row sm:space-x-1 insert" style="margin-top:0; margin-bottom:0;"><ins class="adsbygoogle sm:w-1/2" style="display:block; text-align:center;" data-ad-layout="in-article" data-ad-format="fluid" data-full-width-responsive="true" data-ad-slot="3352989513" data-ad-client="ca-pub-3373908032421588" data-adtest="off"></ins><script>(adsbygoogle = window.adsbygoogle || []).push({});</script><ins class="adsbygoogle sm:w-1/2" style="display:block; text-align:center;" data-ad-layout="in-article" data-ad-format="fluid" data-full-width-responsive="true" data-ad-slot="3352989513" data-ad-client="ca-pub-3373908032421588" data-adtest="off"></ins><script>(adsbygoogle = window.adsbygoogle || []).push({});</script></div></p></li><li><p><span> Nachtschweiß</span></p></li><li><p><span> Palpitationen</span></p></li></ul></div></section><section><span></span><h3 id="toc-7"><span></span><span><span>Interpretation der Befunde</span></span></h3><div><p><span>Die Anamnese und die körperliche Untersuchung lassen oft auf eine Ursache schließen und geben Hinweise für weitere Untersuchungen (</span><span><span><span>1</span></span></span><span>; siehe Tabellen </span><span><a target="_blank"><span>Ursachen der akuten Dyspnoe</span></a></span><span>, </span><span><a target="_blank"><span>Ursachen der subakuten Dyspnoe</span></a></span><span> und </span><span><a target="_blank"><span>Ursachen der chronischen Dyspnoe</span></a></span><span>). Mehrere Befunde sind bemerkenswert:</span></p><ul><li><p><span><span><span>Giemen</span></span></span><span> ist ein Hinweis auf </span><span><span><span>Asthma</span></span></span><span> oder chronische obstruktive </span><span><span><span>Lungenerkrankung</span></span></span><span>.</span></p></li><li><p><span>Bei </span><span><span><span>Stridor</span></span></span><span> ist an eine extrathorakale Atemwegsobstruktion (z. B. Fremdkörperaspiration, </span><span><span><span>Epiglottitis</span></span></span><span>, </span><span><span><span>Stimmbandfunktionsstörung</span></span></span><span>) zu denken.</span></p></li><li><p><span>Feuchte RG deuten auf eine Links</span><span><span><span>herzinsuffizienz</span></span></span><span>, oder eine </span><span><span><span>interstitielle Lungenerkrankung</span></span></span><span> hin oder, wenn gleichzeitig Anzeichen für eine Konsolidierung vorliegen, auf eine </span><span><span><span>Pneumonie</span></span></span><span>.</span></p></li></ul><p><span> Allerdings können die Symptome und Anzeichen von lebensbedrohlichen Erkrankungen wie Ischämie und Lungenembolie unspezifisch sein. Darüber hinaus ist die Schwere der Symptome nicht immer proportional zu der Schwere der Ursache (z. B. kann eine Lungenembolie bei fitten, gesunden Menschen nur eine milde Dyspnoe verursachen). Daher ist ein hohes Maß an Misstrauen bei diesen häufigen Erkrankungen angebracht. Es ist oft sinnvoll, diese Krankheiten auszuschließen, bevor die Dyspnoe einer weniger schwerwiegenden Ursache zugeschrieben wird.</span></p><p><span>Die Berücksichtigung der Prä-Test-Wahrscheinlichkeit und manchmal klinische Vorhersageregeln können helfen, das Risiko abzuschätzen </span><span><span><span>Lungenembolie</span></span></span><span>. Es ist zu beachten, dass eine normale Sauerstoffsättigung eine Lungenembolie nicht ausschließt.</span></p><p><span>Das </span><span><span><span>Hyperventilationssyndrom</span></span></span><span> ist eine Ausschlussdiagnose. Da eine Hypoxie eine Tachypnoe und Unruhe verursachen kann, ist es unklug anzunehmen, dass jeder schnell atmende, unruhige, junge Mensch an einem Hyperventilationssyndrom leidet.</span><div class="sm:flex sm:items-center sm:justify-center sm:flex-row sm:space-x-1 insert" style="margin-top:0; margin-bottom:0;"><ins class="adsbygoogle sm:w-1/2" style="display:block; text-align:center;" data-ad-layout="in-article" data-ad-format="fluid" data-full-width-responsive="true" data-ad-slot="3352989513" data-ad-client="ca-pub-3373908032421588" data-adtest="off"></ins><script>(adsbygoogle = window.adsbygoogle || []).push({});</script><ins class="adsbygoogle sm:w-1/2" style="display:block; text-align:center;" data-ad-layout="in-article" data-ad-format="fluid" data-full-width-responsive="true" data-ad-slot="3352989513" data-ad-client="ca-pub-3373908032421588" data-adtest="off"></ins><script>(adsbygoogle = window.adsbygoogle || []).push({});</script></div></p></div></section><section><span></span><h3 id="toc-8"><span></span><span><span> Tests</span></span></h3><div><p><span>Eine Pulsoxymetrie sollte bei allen Patienten durchgeführt werden, ebenso ein Röntgenthorax, sei denn die Symptome stammen eindeutig von einer leichten oder mittelschweren Exazerbation einer bestehenden Krankheit. Zum Beispiel benötigen Patienten mit Asthma oder Herzinsuffizienz keine Röntgenaufnahme bei jeder Entzündungsepisode, außer die klinischen Befunde lassen eine andere Ursache oder eine ungewöhnlich schwere Attacke vermuten.</span></p><p><span> Bei den meisten Erwachsenen sollte ein EKG durchgeführt werden, um eine Myokardischämie zu diagnostizieren (und "serum cardiac marker testing", wenn der starke Verdacht besteht), es sei denn, eine Myokardischämie kann klinisch ausgeschlossen werden.</span></p><p><span>Bei Patienten mit schwerem oder sich verschlechterndem Atemstatus sollten arterielle Blutgase gemessen werden, um die Hypoxämie genauer zu quantifizieren, PaCO2 zu messen, den</span><span><span><span>Säure-Basen-Status</span></span></span><span> als mögliche Ursache von Hyperventilation zu diagnostizieren und den alveolären-arteriellen Gradienten zu berechnen. Auch ein Basis-Stoffwechselpanel zur Messung des Bikarbonatspiegels kann nützlich sein, um die Chronizität einer </span><span><span><span>respiratorischen Azidose</span></span></span><span> zu beurteilen.</span></p><p><span>Patienten, die nach Röntgenthorax und EKG keine eindeutige Diagnose haben und ein moderates oder hohes Risiko für Lungenembolie besitzen (aufgrund einer klinischen Vorhersageregel) sollten sich einer CT-Angiographie oder einer Ventilations-/Perfusionsszintigraphie unterziehen. Patienten mit einem geringen Risiko sollten eventuell einen D-Dimer-Test durchführen (normale D-Dimer-Werte schließen eine Lungenembolie bei einem Patienten mit geringem Risiko definitiv aus).</span></p><p><span> Bei chronischer Dyspnoe sollte eine weitere gezielte Diagnostik wie CT, Lungenfunktionsprüfungen, Echokardiographie und Bronchoskopie erfolgen. Wenn die Erstuntersuchung nicht schlüssig ist, kann ein </span><span><span><span>kardiopulmonaler Belastungstest</span></span></span><span> in Betracht gezogen werden.</span></p><div><div><div><p>Klinischer Rechner<div class="sm:flex sm:items-center sm:justify-center sm:flex-row sm:space-x-1 insert" style="margin-top:0; margin-bottom:0;"><ins class="adsbygoogle sm:w-1/2" style="display:block; text-align:center;" data-ad-layout="in-article" data-ad-format="fluid" data-full-width-responsive="true" data-ad-slot="3352989513" data-ad-client="ca-pub-3373908032421588" data-adtest="off"></ins><script>(adsbygoogle = window.adsbygoogle || []).push({});</script><ins class="adsbygoogle sm:w-1/2" style="display:block; text-align:center;" data-ad-layout="in-article" data-ad-format="fluid" data-full-width-responsive="true" data-ad-slot="3352989513" data-ad-client="ca-pub-3373908032421588" data-adtest="off"></ins><script>(adsbygoogle = window.adsbygoogle || []).push({});</script></div></p></div><div><div><p><a aria-expanded="false" tabindex="0" target="_blank">A-a Gradient</a></p></div></div></div></div></div></section><section><span></span><h3 id="toc-9"><span></span><span><span> Evaluationshinweis</span></span></h3><div><ol><li><p><span>1. </span><a href="https://pubmed.ncbi.nlm.nih.gov/22336677/" rel="noopener nofollow" target="_blank">Parshall MB, Schwartzstein RM, Adams L, et al</a><span>: An Official American Thoracic Society Statement: Update on the mechanisms, assessment, and management of dyspnea. </span><i><span>Am J Respir Crit Care Med</span></i><span> 185:435–452, 2012.</span></p></li></ol></div></section></div></section><section><h2 data-originaltitle=" Therapie" id="toc-10"><span><span>Behandlung der Dyspnoe</span></span><span></span></h2><div><p><span> Therapie bedeutet Behandlung der zugrunde liegenden Störungen.</span></p><p><span>Hypoxie (bei fehlender kompensatorischer Hyperventilation) wird bei Bedarf mit zusätzlichem Sauerstoff behandelt, um eine Sauerstoffsättigung </span><span><span>></span></span><span> 88% oder einen PaO2 </span><span><span>></span></span><span> 55 mmHg (> 7,3 kPa) aufrechtzuerhalten, da Werte oberhalb dieser Schwellenwerte eine ausreichende Sauerstoffversorgung des Gewebes gewährleisten. Werte unter diesen Grenzen sind auf dem steilen Anteil der Sauerstoff–Hämoglobin-Dissoziationskurve lokalisiert, wo bereits ein geringer Abfall der Sauerstoff–Spannung zu starkem Abfall der Hämoglobin-Sättigung führen kann. Die Sauerstoffsättigung sollte bei </span><span><span>></span></span><span> 93% gehalten werden, wenn die myokardiale oder zerebrale Ischämie ein Problem darstellt, obwohl Daten darauf hindeuten, dass zusätzlicher Sauerstoff bei der Behandlung des akuten Myokardinfarkts nicht vorteilhaft ist, es sei denn, der Patient hat eine Hypoxie (</span><span><span><span>1</span></span></span><span>).</span></p><p><span> Die Gabe von Morphin 0,5–5 mg IV kann helfen, dem Patienten die Angst zu nehmen und die als unangenehm empfundene Atemnot bei verschiedenen Erkrankungen zu lindern, wie z. B. bei Myokardinfarkt, Lungenembolie und der häufig vorkommenden Dyspnoe präfinaler Patienten. Bei Patienten mit akuten Atemwegsobstruktionen (z. B. Asthma, chronische obstruktive Lungenerkrankung) können Opiate durch eine Verminderung des Atemantriebs den Sauerstoffverbrauch des Zwerchfells reduzieren, was zu einer schnelleren Rekompensation führen kann.</span></p><section><span></span><h3 id="toc-11"><span></span><span><span>Literatur zur Therapie</span></span></h3><div><ol><li><p><span>1. </span><a href="https://pubmed.ncbi.nlm.nih.gov/27991651/" rel="noopener nofollow" target="_blank">Cabello JB, Burls A, Emparanza JI, Bayliss SE, Quinn T</a><span>. Oxygen therapy for acute myocardial infarction.</span><i><span>Cochrane Database Syst Rev</span></i><span> 2016;12(12):CD007160. Veröffentlicht am 19. Dezember 2016 doi:10.1002/14651858.CD007160.pub4</span></p></li></ol><div class="sm:flex sm:items-center sm:justify-center sm:flex-row sm:space-x-1 insert" style="margin-top:0; margin-bottom:0;"><ins class="adsbygoogle sm:w-1/2" style="display:block; text-align:center;" data-ad-layout="in-article" data-ad-format="fluid" data-full-width-responsive="true" data-ad-slot="3352989513" data-ad-client="ca-pub-3373908032421588" data-adtest="off"></ins><script>(adsbygoogle = window.adsbygoogle || []).push({});</script><ins class="adsbygoogle sm:w-1/2" style="display:block; text-align:center;" data-ad-layout="in-article" data-ad-format="fluid" data-full-width-responsive="true" data-ad-slot="3352989513" data-ad-client="ca-pub-3373908032421588" data-adtest="off"></ins><script>(adsbygoogle = window.adsbygoogle || []).push({});</script></div></div></section></div></section><section><h2 data-originaltitle="Wichtige Punkte" id="toc-12"><span><span>Wichtige Punkte</span><span></span></span><span></span></h2><div><ul><li><p><span>Die Pulsoxymetrie ist ein wesentlicher Bestandteil der Untersuchung.</span></p></li><li><p><span> Eine niedrige Sauerstoffsättigung (</span><span><span><</span></span><span> 90%) zeigt ein ernstes Problem auf, jedoch bedeutet eine normale Sättigung nicht, dass kein Problem besteht.</span></p></li><li><p><span> Der Einsatz der Atemhilfsmuskulatur, eine plötzlich abfallende Sauerstoffsättigung oder eine Bewusstseinstrübung machen eine dringende Abklärung und einen Krankenhausaufenthalt erforderlich</span></p></li><li><p><span> Myokardischämie und Lungenembolie sind relativ häufig, aber die Symptome und Beschwerden können unspezifisch sein.</span></p></li><li><p><span>Eine Exazerbation der bestehenden Erkrankung (z. B. 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