课件：β受体阻滞剂在心力衰竭治疗中的指南和临床应用协和阜外医院张健杨跃进.ppt

* * * * * * * The figure shows that the IHD patients with CHF, when they met an ischemia on set, the AHF will occur and the AHF will aggravate the ischemia. This situation become a vicious circle. * Form 2002, we want to investigate whether the treatment of introvenous beta-blocker infusion on the improvement of cardiac ischemia may further improve the acute heart failure so as to find a method in the management of this severe condition. * * When the acute heart failure attacks, we can judge the situation to be associated with ischemia on set. Based on the standard treatment first, and the patients is not responded well to the medication. We try to give the patient Metoprolol intravenous infusion. However, the dosage is needed to titrate carefully. Usually we are according to each patient clinical states. To titrat from low dose, 1-5 mg per time，up titrate to 20 mg. After the patients’ symptoms were relieved we give them oral administration. During the process, we must pay close attention to the HR, BP, ST segment changes of the patient. * As follow, I am going to show you two cases to demonstrate the method. Case 1 Initial Diagnosis Ischemic cardiomyopathy， OMI (anterior and inferior wall) ， Cardiac dilatation, Cardiac function: NYHA IV Diabetes (2 type) After routine treatment of CHF and ischemia, the symptoms were relieved significantely. Case 1 Acute onset of heart failure In the morning at the fourth day after breakfast, the patient suffered severe dyspnea and orthopnea with sweating heavily again. Rales can be heard at all field of both lungs. BP 145/65 mmHg，HR 96 bpm； ECG：ST segments significantly depressed in V5-V6，I、aVL leads； V1-V3，AVR elevated Chest X-ray showed pulmonary edema. Treatments： Routine treatment of acute heart failure with high doses of frusemide, nitroglycerin, nitroprusside, morphine etc. However the patients’ symptoms did not improve in about half an hour. Metoprolol w