Jany B, Bals R, Dreher M, Held M, Jany L, Rembert Koczulla A, Pfeifer M, Randerath W, Watz H, Wilkens H, Steinkamp G
ehem. Medizinische Klinik, Klinik für Pneumologie und Beatmungsmedizin, Klinikum Würzburg Mitte, Würzburg.
Pneumologie, Allergologie, Beatmungsmedizin, Universitätsklinikum des Saarlandes.
Pneumologie. 2019 Nov;73(11):651-669. doi: 10.1055/a-0914-9566. Epub 2019 Sep 9.
When caring for patients with respiratory diseases, always think of the heart! This is especially important for COPD patients, but also for a variety of other disorders of the respiratory system. At the workshop "Luftschlösser", held once more at Wiesbaden, Germany in February 2019 the many and important interactions of the lungs and the heart as well as the therapeutic implications were discussed. Based on pathophysiology, the psycho-social consequences of dyspnea, the leading symptom in patients with lung and heart disease became apparent. A particularly demanding diagnostic and therapeutic situation occurs in patients suffering simultaneously of lung and heart disease. It has been shown how frequently the diagnosis myocardial infarction is missed in COPD patients - and vice versa. Surprisingly, this is also the case in asthmatics with coronary heart disease or heart failure, a fact not readily known in clinical practice. In patients with emphysema and no apparent heart disease, hyperinflation leads to significantly restricted heart function. Reducing hyperinflation by inhaling broncholytics thus improves heart function. Biomarkers are increasingly being used for diagnostic purposes. Their role is being investigated in the large German COPD cohort COSYCONET. Lung patients suffering from more severe heart diseases pose a challenge for therapy in intensive care, especially when ventilated, and weaning from the ventilator is prolonged. Lung vessel diseases are "classic" examples of the intimate interaction of the lungs and the heart. In pulmonary arterial hypertension as well as in chronic thrombo-embolic pulmonary hypertension the lag time between the first symptoms and the definite diagnosis is often unacceptably long. For both diseases of the lung vessels therapeutic options have improved significantly over the last years. Pulmonologists should take care of this increasingly important patient group. Sleep-related breathing disorders and heart function are closely intertwined. Both conditions need special attention after the results of the SERVE-HF trial have been published. But there is no doubt that obstructive sleep apnea represents an independent and important risk factor for cardiovascular disease and needs to be treated according to existing guidelines.This workshop demonstrated impressively the multiple interactions of the respiratory system with cardiac function, resulting diagnostic and therapeutic problems, and means to overcome these problems. Guidelines for respiratory diseases should appropriately address cardiac comorbidity.
在护理呼吸系统疾病患者时，一定要考虑到心脏！这对慢性阻塞性肺疾病（COPD）患者尤为重要，对其他各种呼吸系统疾病患者也同样重要。在2019年2月于德国威斯巴登再次举办的“Luftschlösser”研讨会上，探讨了肺与心脏之间诸多重要的相互作用以及治疗意义。基于病理生理学，呼吸困难这一肺心病患者的主要症状所带来的心理社会后果变得显而易见。患有心肺疾病的患者会出现一种特别棘手的诊断和治疗情况。研究表明，COPD患者漏诊心肌梗死的情况有多常见——反之亦然。令人惊讶的是，患有冠心病或心力衰竭的哮喘患者也是如此，这一事实在临床实践中并不为人熟知。在患有肺气肿且无明显心脏病的患者中，肺过度充气会导致心脏功能显著受限。通过吸入支气管扩张剂减轻肺过度充气可改善心脏功能。生物标志物越来越多地用于诊断目的。其作用正在德国大型COPD队列研究COSYCONET中进行调查。患有更严重心脏病的肺病患者给重症监护治疗带来了挑战，尤其是在使用呼吸机时，撤机时间会延长。肺血管疾病是肺与心脏密切相互作用的“经典”例子。在肺动脉高压以及慢性血栓栓塞性肺动脉高压中，从首次出现症状到明确诊断之间的时间间隔往往长得令人难以接受。在过去几年中，针对这两种肺血管疾病治疗选择有了显著改善。肺科医生应该关注这一越来越重要的患者群体。与睡眠相关的呼吸障碍和心脏功能密切相关。在SERVE - HF试验结果公布后，这两种情况都需要特别关注。但毫无疑问，阻塞性睡眠呼吸暂停是心血管疾病的一个独立且重要的危险因素，需要根据现有指南进行治疗。本次研讨会令人印象深刻地展示了呼吸系统与心脏功能之间的多种相互作用、由此产生的诊断和治疗问题以及克服这些问题的方法。呼吸系统疾病指南应适当考虑心脏合并症。
