Herzrhythmusstörungen

Bei einer Herzrhythmusstörung, auch als Arrhythmie bekannt, kommt es zu einer Unregelmäßigkeit im normalen Herzschlag. Gewöhnlich schlägt das Herz unter Ruhebedingungen circa 60 bis 80 Mal pro Minute. Betroffene empfinden einen unregelmäßigen Herzschlag oft als Herzstolpern oder Herzrasen. Folgen können Ohnmacht, Bewusstlosigkeit, Schwindel, Krampfanfälle, Brustschmerzen oder Brustenge sein. Manchmal kann es auch zum Schock kommen. Von besonderer Wichtigkeit ist es, die Ursache für die Herzrhythmusstörungen ausfindig zu machen und diese möglichst zu therapieren.

Welche Ursachen für Herzrhythmusstörungen sind bekannt?

Herzrhythmusstörungen
Herzrhythmusstörungenmikecogh / Foter / CC BY-SA

Es ist möglich, dass Herzrhythmusstörungen bei gesunden Menschen als ein harmloses Phänomen vorkommen. Doch können sie auch eine Komplikation bei Krankheiten des Herzens oder anderer Organe darstellen, die teilweise lebensbedrohlich sein kann. Die äußeren Ursachen für Arrhythmien sind vielfältig. Hier spielen beispielsweise Nervosität, Angst, Aufregung, übermäßiger Genuss von Koffein, Einnahme von Drogen und Giften, übermäßiger Konsum von Alkohol, Nebenwirkungen bestimmter Medikamente, starker Blähbauch oder fieberhafte Infektionen eine Rolle. Als organische Ursachen für Herzrhythmusstörungen kommen Herzinfarkt, koronare Herzkrankheit, Herzmuskelentzündung, Herzmuskelerkrankungen, Herz- oder Herzklappenfehler, Schilddrüsenüber- oder –unterfunktion, Bluthochdruck, angeborene oder erworbene Störungen der Herzerregung oder Elektrolytstörungen in Frage.

Zwischen welchen Formen von Herzrhythmusstörungen wird unterschieden?

Es muss zwischen verschiedenen Formen von Herzrhythmusstörungen unterschieden werden. Es existieren die Reizbildstörungen, wobei es sich um eine gestörte Bildung der elektrischen Impulse handelt, und die Erregungsleitungsstörungen, unter denen man die gestörte Weiterleitung der Herzerregung versteht. Weiterhin erfolgt eine Unterteilung der Herzrhythmusstörungen nach dem Entstehungsort, wie Herzvorhof oder Herzkammer. Außerdem sind Arrhythmien mit zu langsamen und mit zu schnellem Herzschlag bekannt. Herzschläge, die sich außerhalb des normalen Herzrhythmus’ befinden, werden Extrasystolen genannt.

Welche Symptome sind typisch für Herzrhythmusstörungen?

Teilweise können die Herzrhythmusstörungen nur ab und zu oder in geringer Intensität auftreten, sodass ein unregelmäßiger Herzschlag bei den Betroffenen oft unbemerkt bleibt. Auf der anderen Seite ist es aber auch möglich, dass die Arrhythmien starke Beschwerden und gefährliche Komplikationen hervorrufen. Herzstolpern, Schwindel, Benommenheit, Verwirrtheit, Herzrasen, Krampfanfälle, Ohnmachtsanfälle, kurzzeitiger Bewusstseinsverlust, Herzenge und Herzschmerzen sind möglich Symptome bei Arrhythmien. Komplikationen, die zwar eher selten bei Herzrhythmusstörungen sind, aber auftreten können, sind neben Schlaganfall, Embolien, Herzinfarkt und zunehmender Herzschwäche auch der plötzliche Herztod.

Wie erfolgt die Diagnose?

Menschen, die unter Herzstolpern oder Herzrasen leiden oder denen oft aus unerklärlichen Gründen schwindelig ist, sollten sich Rat bei einem Arzt holen. Wichtig ist es, die Ursachen zu klären. Der Arzt wird den Patient in seiner Anamnese konkret nach den Symptomen und möglichen Vorerkrankungen befragen. Der Anamnese schließt sich eine körperliche Untersuchung an, die das Abhören des Herzes sowie das Messen von Puls und Blutdruck beinhaltet. Von besonderer Wichtigkeit zum Stellen der Diagnose von Arrhythmien ist die Elektrokardiografie (EKG), mit der die elektrischen Ströme im Herzen gemessen werden können. Die Darstellung der Herzaktivität erfolgt als eine Kurve. Mit Hilfe dieser Kurve kann der Arzt die Form der Herzrhythmusstörungen benennen. Zunächst kommt ein Ruhe-EKG zum Einsatz. Im Anschluss kann auch ein Belastungs-EKG durchgeführt werden. Um temporär auftretende Unregelmäßigkeiten des Herzrhythmus’ nachzuweisen, ist ein Langzeit-EKG über 24 Stunden hilfreich. Oft genügen diese Untersuchungen, um eine Arrhythmie zu diagnostizieren. Gelegentlich können noch weitere Tests, wie Herzstrommessungen mittels eines Herzkatheters oder Untersuchungen unter der Einnahme spezieller Medikamente, zum Einsatz kommen.

Wie erfolgt die Therapie bei Herzrhythmusstörungen?

Die Therapie ist abhängig von der Art und dem Ausmaß der Arrhythmie. Bestimmte Herzrhythmusstörungen benötigen keine Behandlung. Führen äußere Ursachen zu einer Arrhythmie, müssen diese zunächst beseitigt werden. Wichtig ist es, Krankheiten, wie Bluthochdruck, koronare Herzkrankheit oder Schilddrüsenfunktionsstörungen, welche unter anderem die Entstehung von Herzrhythmusstörungen begünstigen, zu behandeln. Viele Herzrhythmusstörungen werden mithilfe von Medikamenten therapiert. Dabei handelt es sich häufig um Antiarrhythmika, wie Beta-Rezeptoren-Blocker, Natrium-Kanal-Blocker, Kalium-Kanal-Blocker und Kalzium-Antagonisten. Sie nehmen Einfluss auf den Herzrhythmus, indem sie auf das Erregungsleitungssystem des Herzens wirken. Bei Vorhofflimmern und Vorhofflattern kommen Herzglykoside, wie Digoxin und Digitoxin, zum Einsatz. Langsame Arrhythmien können mittels Parasympatholytika oder Sympathomimetika behandelt werden. Zur Therapie von Vorhofflattern und Vorhofflimmern kann auch eine elektrische Kardioversion verwendet werden, wenn die Medikamente nicht den erwünschten Erfolg erzielt haben. Weiterhin kommen die Hochfrequenzstromablation sowie die Einpflanzung eines Herzschrittmachers oder eines Defibrillators in Frage. Bei einem Herzschrittmacher handelt es sich um ein kleines, batteriebetriebenes Gerät, welches elektrische Impulse an das Herz übermittelt. So ist es möglich den Herzrhythmus zu normalisieren. Das Einsetzen eines Defibrillators wird bei Personen, die ein hohes Risiko für Kammerflimmern haben, in Betracht gezogen. Diese führen im Notfall einen Stromstoß aus, um so einen regelmäßigen Herzschlag wiederherzustellen.

 

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