ESC慢性心衰指南.ppt

Digitalis Glycosides Cardiac glycosides are recommended in atrial fibrillation and symptomatic CHF… in order to improve cardiac function and symptoms… (level B) A combination of digitalis and beta-blockade appears superior to either agent alone (level C) In sinus rhythm digoxin may improve the clinical status in persisting heart failure symptoms due to LV systolic dysfunction (level B). Vasodilators Vasodilators may be used as adjunctive therapy in heart failure for the relief of angina or acute dyspnoe (nitrates) or concomitant hypertension (DHP calcium antagonists) ARBs better choice than nitrates/hydralazine when intolerance to ACE inhibitors (level B) Alpha-blockers are not recommended for heart failure (level B) DHP calcium antagonists have no effect on survival in CHF due to LV systolic dysfunction (level A) Positive Inotropes Inotropic agents are commonly used to limit severe episodes of CHF or as a bridge to transplantation (level C). Use of dobutamine insufficiently documented - prognosis unclear. Higher incidence of treatment - related complications with milrinone. Prolonged or repeated oral therapy with available agents (cAMP dependent) increases mortality (level A) Short-term levosimendan (calcium sensitiser) appears to be safer than dobutamine. Its long term effect on mortality needs to be confirmed (level C) Antiarrhythmics in Heart Failure In general there is no indication for the use of anti-arrhythmics in CHF. Specific indications: atrial fibrillation, non-sustained or sustained VT Class I agents should be avoided (level C) Beta-blockers reduce sudden death in CHF (level A) Amiodarone is effective against most common supra-and ventricular arrhythmias (level B), but routine administration in CHF is not justified (level B) There is no specifically defined role for ICD in CHF (level C), but it improves survival in cardiac arrest or sustained VT associated with LV dysfunction (level A) Antiarrhythmics in heart failure (cont′d) Amiodarone is effecti