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Opinion statement
相似文献
– | Physicians must aggressively treat heart failure in the early stages to prevent disease progression and improve survival. Early treatment implies early diagnosis of left ventricular (LV) dysfunction, before the onset of symptoms. Patients with risk factors for the development of heart failure, especially coronary disease or hypertension, should undergo echocardiography to evaluate LV function. Patients with LV systolic dysfunction should be further evaluated to determine the type of cardiac dysfunction, uncover correctable etiologic factors, determine prognosis, and guide treatment. |
– | Angiotensin-converting enzyme (ACE) inhibitors and beta-adrenergic blocking drugs improve survival and are integral to the treatment plan. Physicians should prescribe an ACE inhibitor as initial therapy for all patients with LV systolic dysfunction unless there are specific contraindications. The combination of hydralazine and isosorbide dinitrate is an acceptable alternative therapy for patients who cannot take ACE inhibitors. |
– | Diuretics should be used if there are signs or symptoms of volume overload. |
– | Beta-adrenergic blocking drugs should be added to therapy in stable patients with mild to moderate heart failure after optimal treatment with ACE inhibitors, diuretics, or other vasodilators. |
– | Digoxin should be used routinely in patients with severe heart failure and should be added to therapy in patients with mild to moderate heart failure who remain symptomatic despite optimal doses of ACE inhibitors and diuretics. |
– | Spironolactone should be added, but electrolytes should be closely monitored. |
– | Warfarin anticoagulation should be considered in patients with a left ventricular ejection fraction (LVEF) of 35% or less. |
– | Until survival data exist, angiotensin receptor blockers (ARBs) should not be used as initial therapy or as sole therapy but can be used for ACE-intolerant patients or can be added to standard heart failure therapy. |
– | Outpatient use of intravenous inotropic therapy should be avoided. |
– | Patients with severe heart failure should have peak oxygen consumption measured to quantify functional impairment, determine prognosis, and identify the need for advanced heart failure therapy. |
– | Patients who remain symptomatic while receiving optimal standard therapy should be referred early to a specialized heart failure center. |
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Chronic heart failure (CHF) remains an important and increasing public health care problem. Not until recently it has been recognised that CHF is a chronic progressive disorder affecting different physiological and metabolic pathways. Nowadays CHF is reviewed as the consequence of an interplay of haemodynamic, neurohormonal, immunological, and endocrine mechanisms, initially thought to have beneficial adaptive effects for the organism to compensate the heart's inability to pump properly. However, these secondary changes eventually contribute to further deterioration of CHF. This review focuses on metabolic features observed in patients with CHF and discusses immunological and neuroendocrine aspects and their potential contribution to the pathogenesis of CHF. The overall evidence suggests that advanced CHF is a multifactorial metabolic syndrome that can lead to cardiac cachexia and then carries a very poor prognosis. Joint efforts of cardiologists, endocrinologists, and immunologists are required to develop therapeutic strategies able to improve the metabolic status of CHF patients. 相似文献
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Chronic heart failure and micronutrients 总被引:2,自引:0,他引:2
Heart failure (HF) is associated with weight loss, and cachexia is a well-recognized complication. Patients have an increased risk of osteoporosis and lose muscle bulk early in the course of the disease. Basal metabolic rate is increased in HF, but general malnutrition may play a part in the development of cachexia, particularly in an elderly population. There is evidence for a possible role for micronutrient deficiency in HF. Selective deficiency of selenium, calcium and thiamine can directly lead to the HF syndrome. Other nutrients, particularly vitamins C and E and beta-carotene, are antioxidants and may have a protective effect on the vasculature. Vitamins B6, B12 and folate all tend to reduce levels of homocysteine, which is associated with increased oxidative stress. Carnitine, co-enzyme Q10 and creatine supplementation have resulted in improved exercise capacity in patients with HF in some studies. In this article, we review the relation between micronutrients and HF. Chronic HF is characterized by high mortality and morbidity, and research effort has centered on pharmacological management, with the successful introduction of angiotensin-converting enzyme inhibitors and beta-adrenergic antagonists into routine practice. There is sufficient evidence to support a large-scale trial of dietary micronutrient supplementation in HF. 相似文献
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Bruthans J 《Vnitr?ní lékar?ství》2000,46(3):174-177
Ageing of the population, advances in the treatment of cardiovascular diseases and in the treatment of chronic heart failure cause a rapid increase of the prevalence of chronic heart failure in the population and of the number of hospital admissions on account of this diagnosis. The majority of patients with chronic heart failure are over 65 years and their ratio is increasing. The diagnosis clinical course and treatment of old patients with chronic hearth failure has specific features which become more marked with advancing age. As a role other associated diseases are present as well as factor which cause deterioration of chronic hearth failure, complicate the diagnosis and treatment. With regard to the large number in the population and the patients age ambulatory care of patients with chronic heart failure will also in future be mainly ensured by general practitioners in close collaboration with cardiologist and specialist in internal medicine. A further progression of the number and severity of hospital admissions on account of chronic heart failure may be foreseen. 相似文献
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慢性心衰时的心肌细胞凋亡及其治疗对策 总被引:1,自引:0,他引:1
细胞凋亡也称程序性细胞死亡,源于希腊语,语指细胞的死亡犹如秋天的树叶或花瓣的凋落,由Kerr等于1972年首先引入这一术语,用于描述与细胞坏死具有不同形态学特征的细胞死亡方式[1].这是一种主动的、由基因控制、伴有蛋白质生物合成过程的细胞主动死亡,对后生动物的发育及自身平衡具重要作用,但不适当的细胞凋亡可导致多种疾病的发生. 相似文献
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慢性心力衰竭与肾损害 总被引:2,自引:0,他引:2
范利 《中华老年医学杂志》2010,29(3)
流行病学调查结果显示,心血管疾病的危险因素如高血压、糖尿病、脂代谢紊乱、吸烟和代谢综合征等同样是慢性肾脏疾病的危险因素.心血管疾病的新型标志物包括肌钙蛋白、N-末端脑利钠肽前体、胱抑素和超敏C-反应蛋白等不仅可以预测所有人群的心血管原性死亡,同时也是肾原性死亡的重要预测因素,并受肾排泌能力下降等因素的干扰~([1]). 相似文献
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Leptin: a parameter for metabolic changes in heart failure 总被引:3,自引:0,他引:3
Richartz BM Lotze U Krack A Gastmann A Küthe F Figulla HR 《Zeitschrift für Kardiologie》2001,90(4):280-285
OBJECTIVE: Advanced chronic heart failure is a hypercatabolic state with an imbalance between anabolic and catabolic metabolism and finally progressive loss of both muscle mass and adipose tissue. Leptin, the product of the obesity gene, is a hormone secreted by adipocytes. Therefore, we tested the hypothesis that plasma leptin concentrations are reduced in advanced chronic heart failure. METHODS: In 20 patients with chronic congestive heart failure (LVEF 23 +/- 6%) and 20 healthy controls (LVEF 65 +/- 8%) matched for gender, age, and body mass index, fasting plasma leptin (ELISA) and TNF alpha (ELISA) were measured. Follow-up examination was performed after 1 year. RESULTS: The fasting plasma leptin concentrations of patients with NYHA grade III (8.4 +/- 3.8 ng/ml*) and NYHA grade IV (4.6 +/- 2.4 ng/ml dagger) were significantly lower as compared with the controls (11.2 +/- 3.1 ng/ml; *p < 0.05, dagger p < 0.01). In patients with NYHA grade II plasma leptin levels were significantly elevated as compared with the healthy controls (14.9 +/- 4.2 ng/ml). TNF alpha was higher in heart failure patients than in healthy controls (8.6 +/- 3.6 pg/ml; 5.9 +/- 2.1 pg/ml; respectively; p < 0.05), but did not correlate with the NYHA functional class. Mortality of the controls was 0%, whereas 15% (n = 3) in the congestive heart failure group; one patient (5%) needs an urgent heart transplantation. All of those patients had leptin concentrations below 5 ng/ml. CONCLUSIONS: Plasma leptin concentrations correlate with the NYHA functional class suggesting anabolic metabolism in NYHA class II and catabolic metabolism in advanced heart failure which might be of prognostic relevance. 相似文献
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尽管对于治疗慢性心力衰竭(chronic heart failure,CHF)已经取得了重大的进展,但是CHF的病死率仍然很高,轻度CHF每年有5%~15%的病死率,而重度CHF患者每年的病死率可高达20%~50%. 相似文献
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