心衰基本常识心衰基本常识与CRT植入适应证.ppt

Most patients with heart failure require a diuretic to relieve fluid retention. In addition to rapidly decreasing symptoms such as pulmonary congestion and peripheral edema, diuretics improve exercise tolerance and facilitate the use of other drugs indicated for heart failure. Treatment with a diuretic is generally started at a low dose and then gradually tapered upward until a threshold dose is established. Some patients with heart failure can be taught to adjust their diuretic dose themselves based on changes in body weight, which should be monitored daily. After fluid retention has resolved, diuretic therapy is continued to prevent its recurrence. Electrolyte depletion is a frequent complication of long-term diuretic therapy; therefore, electrolyte levels need to be monitored frequently during initial stages of therapy and after increases in diuretic dose. Diuretics are usually used along with ACE inhibitors and beta-blockers in heart failure, and should never be used alone. Increased doses of diuretics have been associated with increased mortality. Angiotensin Converting Enzyme (ACE) inhibitors are recommended for all heart failure patients, whether they are symptomatic or not. Use of ACE inhibitors relieves symptoms and improves exercise tolerance in patients with chronic heart failure. Data from placebo-controlled trials show that ACE inhibitors can also reduce the risk of death and disease progression in heart failure patients. The benefits of ACE inhibitor therapy may not become apparent for 1-2 months after initiation of treatment. But even in the absence of symptomatic improvement, continued long-term ACE inhibitor therapy is recommended to reduce the risk of death or hospitalization. Most patients with heart failure tolerate long-term ACE inhibitor therapy. Potential side effects include a decrease in blood pressure, transient worsening of kidney function, hyperkalemia, and chronic cough. Angioedema, a disorder characterized by the development of large