心衰的诊断及鉴别诊断2015.10题材.pptVIP

* The Cardiovascular Continuum – Cardio-protective Interventions by Beta-Blockade ? Brian Tomlinson Department of Medicine Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR ? Beta-blockers have become established as a cornerstone of the treatment of the cardiovascular continuum. They were originally developed for symptomatic relief of angina,1 and were subsequently shown to be effective in the treatment of hypertension.2 Early studies of beta-blockade in acute myocardial infarction showed significant reductions in mortality and morbidity,3 and benefits of early and continued beta-blockade were still apparent after the introduction of antiplatelet and thrombolytic treatments in studies such as the thrombolysis in myocardial infarction (TIMI) II trial.4 More recently, it was found in the ClOpidogrel and Metoprolol in Myocardial Infarction Trial (COMMIT) that the use of metoprolol given intravenously followed by oral dosing reduced the risks of reinfarction and ventricular fibrillation, but increased the risk of early cardiogenic shock, reemphasizing it is important to start beta-blocker therapy when the haemodynamic condition has stabilised.5 ? Current guidelines recommend beta-blockers in chronic stable coronary artery disease (CAD)6, 7 and despite the advent of new drug and intervention treatment modalities and recommendations for aggressive individualized therapy in acute coronary syndromes, beta-blockers still have an important role in secondary prevention for patients with coronary and other atherosclerotic vascular diseases.8 Likewise, in chronic systolic heart failure certain beta-blockers have clearly proven benefits and their use is recommended by current guidelines.9 The benefits of beta-blockers in these conditions appear to be mainly due to inhibition of beta1-receptors and the drugs which are more beta1-selective are recommended including atenolol, bisoprolol and metoprolol and in addition in heart failure the vasodilating beta-blockers