原创力文档- 1、本文档共35页，可阅读全部内容。
- 2、原创力文档（book118）网站文档一经付费（服务费），不意味着购买了该文档的版权，仅供个人/单位学习、研究之用，不得用于商业用途，未经授权，严禁复制、发行、汇编、翻译或者网络传播等，侵权必究。
- 3、本站所有内容均由合作方或网友上传，本站不对文档的完整性、权威性及其观点立场正确性做任何保证或承诺！文档内容仅供研究参考，付费前请自行鉴别。如您付费，意味着您自己接受本站规则且自行承担风险，本站不退款、不进行额外附加服务；查看《如何避免下载的几个坑》。如果您已付费下载过本站文档，您可以点击 这里二次下载。
- 4、如文档侵犯商业秘密、侵犯著作权、侵犯人身权等，请点击“版权申诉”（推荐），也可以打举报电话：400-050-0827(电话支持时间：9:00-18:30)。
NeedforSelectiveAldosteroneBlockadeforPatientswithTransientorPersistentHeartFailureDuringHospitalisationforAMIProfessorCRichardCONTIUniversityofFloridaCollegeofMedicine,Gainsville,Florida(USA)
HospitalEventsinNRMIAMIPatientsEVENTAMI+CHF(%)AMI(%)Stroke2.21.4AVblock5.74.6VTorVF11.99.09Rupture/EMD1.81.0Unexpectedcardiacarrest8.34.4LOS7.15.3RecurrentMI3.02.7Death21.47.2
AMIandHFConclusionsfromNMRICHFandAMIisahighrisksituationDespitethehighrisk,thesepatientsarelessfrequentlytreatedwithmedicationswithprovenmortalitybenefitorwithprimaryreperfusionstrategiesNoneofthesepatientsweretreatedwithaldactoneoreplerenone
CardiacEchoperformedwithin24hrsafterAMIPrognosisafterMyocardialInfarction
GRACE:ImpactofHeartFailure
onCumulativeMortalityFromACSACS=acutecoronarysyndromes.StegPGetal.Circulation.2004;109:494-499.TimetoDeathWithin6Months(n=10,771)0.30.20.10.0012346HR=3.8(95%CI,3.33to4.36)
HeartfailureatadmissionNoheartfailureatadmissionProportionDead5
ACE-I=angiotensin-convertingenzymeinhibitor;
AngI=angiotensinI;ARB=angiotensinIIblocker.Pathophysiologic
effectson
cardiovascular
systemAngIIAngIAngiotensinogenReninNa+/H2O
retention
K+,Mg++lossAldosteroneACEACE-iNon-RAASStimulatorsARBARBAldosterone
BlockersAldosteroneNon-RAASstimulatorsAlternativePathwaysAldosterone:ImportantComponentof
Renin-Angiotensin-AldosteroneSystem
FibrosisFibrosisNofibrosisAdaptedfromWeberKT,BrillaCG.Circulation1991;83:1849-1865.UnilateralRenalArteryStenosisAldosteroneInfusioninUninephricRatInfrarenalAorticBandingPlasmaHBPLVHFibrosisAngiotensinIIAldosteroneAngiotensinIIAldosteroneAngiotensinIIAldosteroneYesYesYesYesYesYesYesYesNoHBP=highbloodpressure;LVH=leftventricularhypertrophyAldosteroneStimulatesMyocardialFibrosis
MyocardialFibrosisinHypertensionandCHF:TheAldosteroneHypothesis?AldosteroneCardiacfibroblasts?
文档评论（0）