心衰问答医疗课件.ppt

Medical Management of Heart Failure Drugs that improve symptoms furosemide thiazide diuretics spironolactone digoxin ACE Inhibitors beta blockers aldosterone antagonists Drugs that improve prognosis ACE inhibitors beta blockers spironolactone* Rationale for Treatment of Heart Failure LV dysfunction sympathetic activation Renin- angiotensin Adrenal stimulation epinephrine norepinephrine angiotensin I aldosterone angiotensin II BABs ACEIs ARBs spironolactone Beta Blocker Trials Mortality per year Enalapril vs Placebo in Symptomatic CHFCONSENSUS Probability of Death Months Question 15The following are all adverse effects of beta blockers except: bronchospasm bradycardia hypotension depression anxiety Beta BlockersAdverse Effects excessive fatigue bradycardia, heart block hypotension reactive airways mood disturbances, depression intermittent claudication impotence Beta Blockers in Heart FailurePractical Tips start with low doses (3.125-6.25 mg carvedilol bid or 6.25-12.5 mg metoprolol bid) increase dose slowly at intervals of 2 weeks or more avoid in patients with bronchospasm or advanced heart block without pacemaker improvement symptomatically and objectively may be slow avoid abrupt withdrawl Question 16The following are all adverse effects of ACE Inhibitors except: Renal dysfunction bradycardia hypotension cough hyperkalemia ACE InhibitorsAdverse Effects hypotension renal dysfunction hyperkalemia cough skin rash taste disturbance angioneurotic edema Question 17Current evidence supports the following approach with respect to digoxin: Should be used in all patients with LV dysfunction Should be used chronically in patients with controlled heart failure to improve symptom status Should be used chronically in patients with controlled heart failure to improve prognosis Should be used acutely in patients with new onset heart failure Digoxin has no role in heart failure patients Digitalis and other Inotropic DrugsRecommendations to improve sympt