充血性心衰藥物-全文預(yù)覽
【正文】 Receptor Antagonists) are as effective as ACE inhibitors in treating heart failure, but it appears that therapeutic efficacy may be parable ? losartan, candesartan, valsartan Inotropic Drugs digitalis ? The beneficial effects of cardiac glycosides in the treatment of heart failure have been attributed to a positive inotropic effect on failing myocardium and efficacy in controlling the ventricular rate response to atrial fibrillation. The cardiac glycosides also modulate autonomic nervous system activity, and it is likely that this mechanism contributes substantially to their efficacy in the management of heart failure. ? Positive Inotropic Effect （抑制 Na+,K+ATPase ） ? Electrophysiological Actions （加上增強(qiáng)迷走） ? Regulation of Sympathetic Nervous System Activity – There is evidence that digitalis may act directly to sensitization of baroreceptor response and thereby exert some of its beneficial effects through reduction of sympathetic tone ? The recent Digitalis Investigation Group (DIG) clinical trial indicated digoxin did not reduce overall mortality in patients with heart failure (who were receiving diuretics and ACE inhibitors), but did reduce the rate of hospitalization Other inotropic agents 只適用于急性心衰，長(zhǎng)期應(yīng)用于慢性心衰后，病人死亡率增加。 （病馬加鞭） ? longterm treatment directed towards neurohormonal factors with ACE inhibitors and betablockers can decrease mortality Consensus remendations for the management of CHF ? Patients with heart failure should first be evaluated to assess LV ejection fraction. Patients with systolic dysfunction (EF 40%) should then undergo the following treatment: ? 水 鈉 潴留：利尿 藥 ? ACEIs， ARBs 和 /或 betablocker ? 室率快的房 顫 ：強(qiáng)心 苷 （地高辛） ? 重癥患者延 長(zhǎng)壽 命： 醛 固 酮 受體拮抗 劑 ? fluid retention a diuretic. ? ACE inhibitor and betablocker should be initiated and maintained unless specifically contraindicated. （ Patients with severe heart failure should probably not receive a betablocker） ? Digoxin in patients with rapid atrial fibrillation. ? Spironolactone, an aldosterone antagonist, may reduce mortality in patients with severe
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