Zielgerichtete Diagnostik und adäquate Therapie - Akutes Cor pulmonale bei Lungenarterienembolie

high. Otherwise, patients must compensate the acute right heart over-load, and the acute-onset gas exchange impairment – possible consequences are a decrease in ventricular function, a reduction in ventricular ejection performance, or systemic hypotension. To keep the circulation functional, mean pulmonary pressures of about 40 mmHg are required – higher pressures lead to acute right heart failure. If pulmonary embolism is suspected, therefore, rapid action is called for. In addition to the basic diagnostic work-up (echocardiography, multiline CT), D-dimer, troponin or BNP serum levels should be determined in the laboratory, with the aim of initiating necessary therapeutic measures as quickly as possible. Administration of heparin, for example, is already indicated when pulmonary embolism is suspected; thrombolysis is of benefit in particular to patients in stage II disease with right ventricular dysfunction, or patients in whom the disease is already in a more advanced stage of progression. Effective oral anticoagulation as recurrence prophylaxis – which in certain cases may even be life-long, should be considered.