Arterielle Hypertonie und operatives Risiko

摘要

Diseases of the cardiovascular system represent one of the major risk factors for noncardiac and cardiac surgery. Due to the high prevalence in the adult population and the development of consecutive organ dysfunctions, arterial hypertension is an important risk factor that should be evaluated preoperatively. Arterial hypertension is a risk factor for the development of coronary artery disease and could lead to hypertensive crises with left heart failure or the occurrence of cardiac arrhythmias. The evaluation of the perioperative risk should be directed to the intended operation and the characteristic of the arterial hypertension. It is important to discriminate between the hypertensive patient with and without heart failure, because these patients with heart failure have an increased perioperative risk. In the absense of heart failure and if the patient is free of symptoms, preoperative electrocardiographic diagnosic tests (ECG, exercise-ECG) are sufficient. If heart failure or coronary artery disease and/or cardiac arrhythmias are present, an extended cardiovascular diagnostic investigation is necessary (echocardiography, invasive coronary angiography), in order to achieve a stabilization of the cardiac situation before surgery (revascularization, recompensation, antiarrhythmic therapy).