心衰基本常识与CRT植入适应证.ppt

Aldosterone Antagonists Spironolactone, long known for its potassium-sparing diuretic effects, is an aldosterone antagonist, and the only aldosterone antagonist available for clinical use in the US. The RALES study (Randomized Aldactone Evaluation Study), a multi-center mortality trial examined the effect of adding low-dose spironolactone to standard diuretic/ACE inhibitor therapy in HF (NYHA Class III and IV patients) has shown to reduce mortality in heart failure patients1. ACC/AHA Guidelines recommends the use of spironolactone in patients with severe HF. The role of spironolactone in patients with mild to moderate HF has not been defined, and use of the drug cannot be recommended in such individuals 2. Hyperkalemia is a concern. Serum potassium and creatinine should be closely monitored, and patients with a potassium level 5 or creatinine 2.5 should not be treated with spironolactone. While therapy with spironolactone is generally well-tolerated, about 9% of patients in the Randomized Aldactone Evaluation Study experienced gynecomastia (swelling of the mammary glands in the male). 1 McMurray, J and Cleland, J. Heart Failure in Clinical Practice. Second Edition. Martin Dunitz Ltd. p 101. 2 Hunt, SA, et al ACC/AHA Guidelines for the Evaluation and Management of Chronic Heart Failure in the Adult, 2001 pp 23-24 Angiotensin Receptor Blockers Angiotensin receptor blockers, or “ARBs,” are the newest class of drugs to be promoted as a potential treatment for patients with heart failure. ARBs are most often given when a patient cannot tolerate an ACEI. To understand how these unique drugs work, we must first take a closer look at angiotensin II and and the receptors that bind it. Angiotensin II, as we learned previously in this program, is produced from angiotensin I by the action of angiotensin converting enzyme (ACE). As we now know, angiotensin II has a number of potentially adverse effects that contribute to the development and progression of HF, includi