心脏瓣膜病-浙江大学.ppt

* The treatment of heart failure has changed considerably over the past decade, primarily because we now understand the importance of neurohormonal activation in the progression of this disease. In this section we will learn about the treatment of heart failure; however, the focus will be on the ever-expanding armamentarium the pharmacologic agents used to treat this disease. [Note: The material discussed in this section is based on the ACC/AHA Practice Guidelines 2001, Circulation December 2001.] General Measures: An important part of heart failure management is identifying and treating factors that are known to encourage heart failure and its progression. This often requires encouraging patients to adopt lifestyle changes to address these factors. Lifestyle Modifications: Weight Reduction—Obese patients should lose weight Smoking—Smokers should stop smoking Alcohol—Excessive alcohol use, and the use of other cardiotoxic substances, should be avoided Exercise—Improve physical conditioning where appropriate * Digoxin Digoxin has been used in the management of heart failure for more than 200 years, yet it wasn’t formally approved by the FDA for this indication until 1997. Digoxin enhances inotropy (contractility) of cardiac muscle and, at the same time, reduces activation of the SNS and RAAS. These neurohormonal effects are sustained during prolonged treatment with digoxin. Randomized, double-blind, placebo-controlled trials such as PROVED (Prospective Randomized Study of Ventricular Failure and the Efficacy of Digoxin) and RADIANCE (Randomized Assessment of Digoxin and Inhibitors of Angiotensin-Converting Enzyme) have shown that long-term therapy with digoxin reduces symptoms and increases exercise tolerance1. These two trials demonstrated that “patients with mild to moderate chronic heart failure due to left ventricular systolic dysfunction, who are clinically stable on either maintenance therapy of Digoxin and diuretics (PROVED), or with additional background