Kardiologische Rehabilitation in Deutschland

Over the past 20 years the German Pension Insurance has rehabilitated nearly 800,000 patients with coronary heart disease. In particular, phase-II rehabilitation has been established as an integral part of cardiac patient care. However, the decreasing number of participants in phase-III must be seen critically. Today's cardiac rehabilitation is characterised by evidence-based treatment modules and a sophisticated quality assurance system that ensures quality orientation in all aspects, from access to rehabilitation through to aftercare. Future developments such as vocationally-oriented medical rehabilitation and the use of new technologies will further improve cardiac rehabilitation. Positive patient feedback and scientific evidence of the effectiveness of cardiac rehabilitation are further incentives to maintain this forward-looking approach.     

Kardiologische Krankheitsbilder

Knowledge of rare but important clinical disease symptoms in cardiology is of vital importance in the daily routine as severe courses of disease as well as death may be prevented by early diagnosis, effective monitoring and timely initiation of an adequate therapy. In this article an important rhythmological disease, arrhythmogenic right ventricular cardiomyopathy, as well as two significant structural diseases, takotsubo (stress-related) cardiomyopathy and aortic aneurysm related to Marfan syndrome, as well as their implications for clinical practice will be presented.     

Kardiologische Diagnostik nach Schlaganfall

Patients with a stroke often exhibit similar risk factors compared to patients with coronary artery disease. The morbidity and mortality of patients surviving a stroke are strongly determined by cardiac co-morbidities. Moreover, ischemic stroke frequently results from cardiac embolism. Thus, for risk assessment and prevention of cardiovascular events patients should undergo cardiac evaluation after a stroke. Laboratory testing should include blood glucose, coagulation parameters, blood cell count and in the case of suspected acute coronary syndrome cardiac ischemic markers. Assessment of the lipid profile is useful to determine the overall cardiovascular risk. In all patients with a stroke an ECG should be recorded. In those with normal ECG and suspected thromboembolic stroke additional Holter is helpful to detect possible atrial fibrillation. Echocardiography should be performed in all patients with suspected cardioembolic stroke. Moreover, echocardiography may establish the diagnosis of structural heart disease, which has a major impact on prognosis in patients with a stroke.     

Kardiologische Betreuung in der Schwangerschaft

Cardiac diseases are the commonest causes of overall maternal death in pregnancy. Therefore cardiac evaluation, counseling, and management of young women with congenital and acquired heart diseases are of great importance. Advice should ideally be given prior to conception and become a routine part of a specialized pediatric and adult cardiology practice. A timely diagnosis to identify those patients who require lifestyle changes and medical, interventional, or surgical therapy prior to pregnancy is of special importance as well as the recognition of patients with high risks during pregnancy, in whom pregnancy is contraindicated or who should be treated in tertiary centers with multidisciplinary facilities for care.     

Kardiologische Praxis — Quo vadis?

Ohne Zusammenfassung     

Kardiologische Notfälle an Bord von Verkehrsflugzeugen

The incidence of in-flight medical emergencies (IMEs) on board commercial aircraft is increasing annually due to the rising numbers of passengers, increasing average age, and development of ultra-high capacity aircraft. Since systematic studies are not available, the number of IMEs in commercial air traffic is difficult to estimate. In general one should expect 0.25–1 IMEs per 10,000 passengers transported. The majority of events turn out to be of a relatively harmless nature. A possible life-threatening situation may be present in 10% of cases. The vast majority of IMEs consists of syncopal episodes while a true cardiologic condition is found in 6% of cases. For enhanced understanding of the pathophysiologic fundamentals and adapted strategies for treatment in the aviation setting, this article describes the determining factors of altitude physiology, organizational and legal circumstances of in-flight medical response, organizational preventive measures, as well as appropriate medical emergency equipment of selected airlines. This information may be used to develop optimal strategies for treatment of selected cardiologic conditions in airliners.     

Pneumologische Rehabilitation

Comprehensive, multidisciplinary pulmonary rehabilitation may offer substantial benefit for patients with chronic lung diseases. For patients with chronic obstructive pulmonary disease (COPD) in particular, the data for different treatment components are convincing with a high level of evidence. The clinical effects that can be achieved using a multimodal rehabilitative approach may be equivalent or even superior to drug therapy. This article outlines the effectiveness and clinical relevance of pulmonary rehabilitation.     

Medizinische Rehabilitation

Medical rehabilitation is an important part of the German health care system in addition to medical and nursing care. For people with impairments, especially with chronic diseases, rehabilitation aims at emancipated participation in social life. The German pension insurance carries out rehabilitation mainly for gainfully employed people. To be entitled to these benefits legal and personal (medical) requirements must be fulfilled. The rehabilitation concepts of the German pension insurance are interdisciplinary, following the bio-psycho-social model of health and illness. Concepts of rehabilitation are presented exemplarily for musculoskeletal, oncologic, heart/circulation, metabolic/gastrointestinal, and neurological diseases as well as mental disorders. Elements of structure, process, and outcome quality are illustrated. Research topics in rehabilitation are presented.     

Neurologische Rehabilitation

This article describes state of the art concepts of neurological rehabilitation in Germany. In parallel to enormous growth of knowledge in the neurosciences also neurological rehabilitation has made significant progress. The increasing use of concepts of evidence based medicine and an early translation of knowledge from the neurosciences into clinical rehabilitation practice contribute to therapeutic advances. It is now widely accepted, that rehabilitation should start early and should be organized in a multidisciplinary professional team. Therapeutic procedures selected should be evidence based and have to be modified to find custom tailored solutions for individual patients. General rules derived from neuroscientific knowledge have been shown to be useful to design new therapeutic techniques. Neuromodulatory stimulation and special pharmacological treatments provide further options for enhancing results of rehabilitation.     

Pneumologische Rehabilitation

Pulmonary rehabilitation (PR) is an evidence-based interdisciplinary treatment for patients with chronic diseases of the respiratory system who are symptomatic and are impaired in professional and daily activities. In addition to securing occupational and social participation, the targets are improvement of symptoms, physical fitness, quality of life and functional optimization. The indications for PR are fulfilled if, despite adequate curative treatment, relevant physical and psychosocial sequelae due to disease are present in routine daily activities which impede the possibility for normal participation in occupational and social life. The effectiveness of PR is confirmed with the highest level of evidence especially for chronic obstructive pulmonary disease (COPD). Therefore, in all COPD guidelines PR is considered an essential component of long-term management and is recommended above a moderate degree of severity.