如何优化心衰控制？-.ppt

Keep guideline in mind,  walking your own way ! Chronic Heart FailureMore common than we believe ! Chronic Heart Failure A disease state which seldom stops ! Chronic Heart Failure More malignant than we believe ! Evidence based medicine makes difference ! Sudden Death Sudden Death No guideline in most HF patients Walking out from misperceptions ! No 3 Beta-blockers should be avoided in diabetic CHF patients Beta-blockers should be avoided in COPD and CHF patients Beta-blockers and ACE inhibitors should be avoided in elderly CHF patients Low dose of beta blocker /ACEI is not meningful False False False False False All beta blockers or ARB have class effects False To be creative ! No 4 Hypotension Bradycardy Renal dysfunction Hyperkalaemia Low compliance … For example Not easy, but not impossible ! Too much diuretics ? Hypotension Other vasodilators ? Symptomatic ? Time to re-consider ! Negative chronotropic drug (digitalis, CCB with low vascular selectivity ) ? Bradycardy ? Symptomatic ? Time to re-consider ! Daytime ? Evening ? At rest ? Exercise ? Pacemaker ? What shall we do when guideline does NOT exist ? Elderly HFNEF HFNEF: HF with preserved systolic function Michael Fu, MD, PhD, FESC Professor, Senior Consultant Physician Head, Heart Failure Center Medicine Sahlgrenska University Hospital/Sahlgrenska G?teborg, SWEDEN How to optimize heart failure management ? 2 % 10 % CHF: A aged population 0 100 200 300 400 500 600 700 1960 1980 2000 2020 Millions 165 296 403 649 Risk factors: diabetes hypertension Vascular dysfunction Vascular disease Tissue injury (MI, stroke) Pathological remodeling Target organ dysfunction (HF, renal) Sympatikus Angiotensin II aldosterone - The Cardiovascular Continuum Adapted 2003 from Dzau V, Braunwald E. Am Heart J. 1991; Gibbons 1999. Heart failure Death CHF: More malignant than most cancer ! Stewart et