In recent years, there are many ways to treat heart failure, then the specific we know what? Here to see the experts for the majority of patients with heart failure treatment of heart failure combined treatment.
Diuretics, digoxin, angiotensin converting enzyme inhibitors (ACEI), β-blockers in combination with four drugs, even with severe contractile heart failure in patients with improved symptoms, but also improve the prognosis. The key to the success of these drugs (especially ACEI and beta-blockers) is to start with a small dose and then carefully adjust to the target dose.
First, diuretics
Diuretics are still the first choice for the treatment of decompensated heart failure, is the necessary drugs, but the use of the majority of patients with heart failure is not enough, but its long-term role, to be combined with digoxin, ACEI, β receptor block , The majority of the problem is diuretic, physicians often give adequate diuretics to relieve pulmonary edema or acute discomfort, but no further adjustment of the dose, even in patients still have liquid overload. At this point need to carefully check:
1, peripheral edema
2, jugular vein filling situation
3, abdominal a neck reflux situation
4, with or without a slight amount of lung rales, especially those who have sustained breathing, no difficulty at night bursts, need to determine whether the increase in diuretic dose, some patients have drug resistance, need to increase, such as the merger of renal insufficiency, speed Urine dosage up to 200mg or more, high-dose diuretic, attention should pay attention to electrolyte imbalance: low potassium and other easy to fatal arrhythmia, diuretic need to consider the combination of ACEI drugs with potassium, low-dose ammonia Shu Shu is good (RALES trial), the mortality rate of the Amithelium Shu group was reduced by 30, suggesting that the loop diuretics and the diuretics were compared with those of the diuretics Ammonia Shu Tong combined effect is good, it is clear that the body of ammonia can be used against loop diuretics caused by the loss of potassium ions.
Low dose of ammonia body Shu can also be a good tolerance (25mg / day, the low level of serum potassium, to 50mg / day), better than potassium alone, the patient can better adapt, and constant maintenance Blood potassium concentration; but note that in patients with renal insufficiency, can cause hyperkalemia, in the RALES test, with a small dose of ammonia Shu-mediated ACEI did not cause hyperkalemia caused by cardiovascular events, but still need to pay attention to hyperkalemia , So the beginning of the application of new diuretics therapy, (ammonia Shu Shu ACEI), should be measured weight, understanding of the capacity of the state, to understand the electrolyte, plus ACEI to adjust the dose of 1-2 weeks to check blood 1 times, and found that the two Drugs in conjunction with the role of potassium. If the discovery of hyperkalemia, should reduce or disable the ammonia body Shu rather than adjust the ACEI, before dressing, the clinician should exclude exogenous potassium, to determine the non-oral potassium, or eating bananas, grapes or potassium beverages.
Two, digoxin
Large-scale trials have confirmed that digoxin reduces hospital stay, improves symptoms, but does not improve survival, long-term users, such as disabled, will aggravate symptoms, digoxin is still an important drug for the treatment of heart failure, such as the patient's ventricular Ejection fraction is low, but asymptomatic, whether the application of digoxin is still controversial, most experts use digoxin to prevent symptoms, but the evidence is insufficient, should pay more attention to whether to increase the survival rate.
Third, angiotensin converting enzyme inhibitors (ACEI)
For patients with massive heart failure studies, ACEI can improve survival and is reflected in the dose, with the attention of possible adverse reactions (such as hypotension, renal insufficiency), starting from a small dose. In these cases, the clinician likes to use short-acting preparations to quickly reach the blood peak, easy to observe the effect, on the other hand need long-term treatment, short agent to be 3 times / day, the patient is difficult to adapt, but this Class medicine (long top pepper), low price, economy. Is still widely recommended, the initial dose of captopril 6.25mg-12.5mg, tid target dose of 50mg, tid maximum dose of 150mg, tid
Although ACEI is effective, but not all, the key issue is the clinical application of many patients with intolerance, but this is not the case: the beginning of the dose, and then carefully monitor, gradually increase the dose, and no side effects, clinicians need to know, ACEI class Drugs to achieve the goal of improving the prognosis, need to reach a certain target dose. Side effects 1: Hypoglycemia and elevated serum creatinine are often considered evidence of ACEI not to be used, but these side effects are ACEI's increased response to diuretics, reduced diuretic dose, or prolonged maintenance of diuretics, many patients Can be well tolerated by ACEI. 2, cough is another important response, and persistent cough, may be heart failure control or virus infection caused by the emergence of persistent persistent dry cough, especially the application of the first 1-2 months prone to, if not complicated by heart failure Symptoms of aggravation should be considered as ACEI caused by withdrawal within 2 weeks of cough disappeared, can be judged, but simply dry cough is not a withdrawal indications, studies have shown that only 5 of the dry cough is a very serious response. 3, hyperkalemia, rare, should be discontinued, but need to exclude exogenous potassium. 4, elevated serum creatinine, kidney damage, should be excluded from excessive diuresis, renal perfusion caused by insufficient, some patients reduce diuretics can improve creatinine, to determine the serum creatinine caused by ACEI, was disabled; in fact the application of ACEI increased Kidney function is not greater than the event of renal dysfunction, serum creatinine slightly elevated, not ACEI contraindications, but need to monitor renal function; in creatinine increased diabetes, ACEI provides a double benefit, advocate long-term application The 5, low blood pressure
Systolic blood pressure 80-90mmhg, not a contraindication, but should be carefully applied as small as possible, to inform patients as far as possible to avoid orthostatic hypotension, such as hypotension and dizziness, can first disable diuretics 1-2 days, following To a small dose of ACEI, such as blood easily increased, improved symptoms, can restore a small dose of diuretics, and then gradually adjust the ACEI dose, we found that some low blood pressure, with ACEI, but the blood pressure, due to increased output, Offset by peripheral vasodilatation / decreased resistance due to hypotension, and blood pressure rise.
Fourth, β-blockers
Traditionally, heart failure patients should not use β-blockers, because of their negative muscle strength, negative frequency is detrimental to patients, in recent years, large-scale trials found that patients with heart failure long-term use of β-blockers , Such as careful adjustment of the dose, in combination with the other three drugs, can increase the ejection fraction, improve symptoms, prolong survival, but in patients with chronic obstructive pulmonary disease (COPD) is not applicable, because of its bronchospasm, Blood glucose; in the application of heart failure, adjust the dose, should observe whether the fluid retention, especially in a week, every week or every week to adjust the dose, in the early, fatigue, dizziness, fluid retention, need to adjust the heart failure Other drug applications, can delay the adjustment of β-blockers, β-blockers benefit, may be the beginning of the drug after 4-8 weeks side effect, large-scale trials show that the onset of symptoms after the patient improved, Hospitalization time is shortened, the survival rate is increased, it is best to maintain the heart rate at 50-60 times / min, such as less than 50 times, no additional amount, such as the performance of patients can not tolerate signs, should first adjust other anti- Increase or decrease Urine, β-blocker (betaloc), the target dose of 200mg / day, the average dose of 159mg / day, the general situation to be 100mg / day or more, the test shows that the application of β-blockers can make Mild to moderate heart failure patients decreased by 34 to reduce the mortality rate of 49, studies have shown that: β-blockers increased ventricular ejection fraction of 5-7, and can reverse ventricular dysfunction, β-blockers can not tolerate Less, when the treatment of 3-6 months after no effect, may consider the gradual withdrawal, once the patient adjusted to the target dose, need to maintain medication, such as deterioration of the disease can be halved the application of β-blockers, plus diuretics Other drugs, recovery of the disease, and then increase the β-blockers. Long-term medication, due to the increase in the number of β receptors, sensitive to catecholamines, so slow to stop, suddenly disabled, can cause tachycardia, aggravate the condition or sudden death.
In short, patients need to have a long-term treatment plan, which is a chronic disease, need patience and time, do not be too hasty, good to comply with the doctor's orders.
Diuretics, digoxin, angiotensin converting enzyme inhibitors (ACEI), β-blockers in combination with four drugs, even with severe contractile heart failure in patients with improved symptoms, but also improve the prognosis. The key to the success of these drugs (especially ACEI and beta-blockers) is to start with a small dose and then carefully adjust to the target dose.
Diuretics are still the first choice for the treatment of decompensated heart failure, is the necessary drugs, but the use of the majority of patients with heart failure is not enough, but its long-term role, to be combined with digoxin, ACEI, β receptor block , The majority of the problem is diuretic, physicians often give adequate diuretics to relieve pulmonary edema or acute discomfort, but no further adjustment of the dose, even in patients still have liquid overload. At this point need to carefully check:
1, peripheral edema
2, jugular vein filling situation
3, abdominal a neck reflux situation
4, with or without a slight amount of lung rales, especially those who have sustained breathing, no difficulty at night bursts, need to determine whether the increase in diuretic dose, some patients have drug resistance, need to increase, such as the merger of renal insufficiency, speed Urine dosage up to 200mg or more, high-dose diuretic, attention should pay attention to electrolyte imbalance: low potassium and other easy to fatal arrhythmia, diuretic need to consider the combination of ACEI drugs with potassium, low-dose ammonia Shu Shu is good (RALES trial), the mortality rate of the Amithelium Shu group was reduced by 30, suggesting that the loop diuretics and the diuretics were compared with those of the diuretics Ammonia Shu Tong combined effect is good, it is clear that the body of ammonia can be used against loop diuretics caused by the loss of potassium ions.
Low dose of ammonia body Shu can also be a good tolerance (25mg / day, the low level of serum potassium, to 50mg / day), better than potassium alone, the patient can better adapt, and constant maintenance Blood potassium concentration; but note that in patients with renal insufficiency, can cause hyperkalemia, in the RALES test, with a small dose of ammonia Shu-mediated ACEI did not cause hyperkalemia caused by cardiovascular events, but still need to pay attention to hyperkalemia , So the beginning of the application of new diuretics therapy, (ammonia Shu Shu ACEI), should be measured weight, understanding of the capacity of the state, to understand the electrolyte, plus ACEI to adjust the dose of 1-2 weeks to check blood 1 times, and found that the two Drugs in conjunction with the role of potassium. If the discovery of hyperkalemia, should reduce or disable the ammonia body Shu rather than adjust the ACEI, before dressing, the clinician should exclude exogenous potassium, to determine the non-oral potassium, or eating bananas, grapes or potassium beverages.
Two, digoxin
Large-scale trials have confirmed that digoxin reduces hospital stay, improves symptoms, but does not improve survival, long-term users, such as disabled, will aggravate symptoms, digoxin is still an important drug for the treatment of heart failure, such as the patient's ventricular Ejection fraction is low, but asymptomatic, whether the application of digoxin is still controversial, most experts use digoxin to prevent symptoms, but the evidence is insufficient, should pay more attention to whether to increase the survival rate.
Third, angiotensin converting enzyme inhibitors (ACEI)
For patients with massive heart failure studies, ACEI can improve survival and is reflected in the dose, with the attention of possible adverse reactions (such as hypotension, renal insufficiency), starting from a small dose. In these cases, the clinician likes to use short-acting preparations to quickly reach the blood peak, easy to observe the effect, on the other hand need long-term treatment, short agent to be 3 times / day, the patient is difficult to adapt, but this Class medicine (long top pepper), low price, economy. Is still widely recommended, the initial dose of captopril 6.25mg-12.5mg, tid target dose of 50mg, tid maximum dose of 150mg, tid
Although ACEI is effective, but not all, the key issue is the clinical application of many patients with intolerance, but this is not the case: the beginning of the dose, and then carefully monitor, gradually increase the dose, and no side effects, clinicians need to know, ACEI class Drugs to achieve the goal of improving the prognosis, need to reach a certain target dose. Side effects 1: Hypoglycemia and elevated serum creatinine are often considered evidence of ACEI not to be used, but these side effects are ACEI's increased response to diuretics, reduced diuretic dose, or prolonged maintenance of diuretics, many patients Can be well tolerated by ACEI. 2, cough is another important response, and persistent cough, may be heart failure control or virus infection caused by the emergence of persistent persistent dry cough, especially the application of the first 1-2 months prone to, if not complicated by heart failure Symptoms of aggravation should be considered as ACEI caused by withdrawal within 2 weeks of cough disappeared, can be judged, but simply dry cough is not a withdrawal indications, studies have shown that only 5 of the dry cough is a very serious response. 3, hyperkalemia, rare, should be discontinued, but need to exclude exogenous potassium. 4, elevated serum creatinine, kidney damage, should be excluded from excessive diuresis, renal perfusion caused by insufficient, some patients reduce diuretics can improve creatinine, to determine the serum creatinine caused by ACEI, was disabled; in fact the application of ACEI increased Kidney function is not greater than the event of renal dysfunction, serum creatinine slightly elevated, not ACEI contraindications, but need to monitor renal function; in creatinine increased diabetes, ACEI provides a double benefit, advocate long-term application The 5, low blood pressure
Systolic blood pressure 80-90mmhg, not a contraindication, but should be carefully applied as small as possible, to inform patients as far as possible to avoid orthostatic hypotension, such as hypotension and dizziness, can first disable diuretics 1-2 days, following To a small dose of ACEI, such as blood easily increased, improved symptoms, can restore a small dose of diuretics, and then gradually adjust the ACEI dose, we found that some low blood pressure, with ACEI, but the blood pressure, due to increased output, Offset by peripheral vasodilatation / decreased resistance due to hypotension, and blood pressure rise.
Fourth, β-blockers
Traditionally, heart failure patients should not use β-blockers, because of their negative muscle strength, negative frequency is detrimental to patients, in recent years, large-scale trials found that patients with heart failure long-term use of β-blockers , Such as careful adjustment of the dose, in combination with the other three drugs, can increase the ejection fraction, improve symptoms, prolong survival, but in patients with chronic obstructive pulmonary disease (COPD) is not applicable, because of its bronchospasm, Blood glucose; in the application of heart failure, adjust the dose, should observe whether the fluid retention, especially in a week, every week or every week to adjust the dose, in the early, fatigue, dizziness, fluid retention, need to adjust the heart failure Other drug applications, can delay the adjustment of β-blockers, β-blockers benefit, may be the beginning of the drug after 4-8 weeks side effect, large-scale trials show that the onset of symptoms after the patient improved, Hospitalization time is shortened, the survival rate is increased, it is best to maintain the heart rate at 50-60 times / min, such as less than 50 times, no additional amount, such as the performance of patients can not tolerate signs, should first adjust other anti- Increase or decrease Urine, β-blocker (betaloc), the target dose of 200mg / day, the average dose of 159mg / day, the general situation to be 100mg / day or more, the test shows that the application of β-blockers can make Mild to moderate heart failure patients decreased by 34 to reduce the mortality rate of 49, studies have shown that: β-blockers increased ventricular ejection fraction of 5-7, and can reverse ventricular dysfunction, β-blockers can not tolerate Less, when the treatment of 3-6 months after no effect, may consider the gradual withdrawal, once the patient adjusted to the target dose, need to maintain medication, such as deterioration of the disease can be halved the application of β-blockers, plus diuretics Other drugs, recovery of the disease, and then increase the β-blockers. Long-term medication, due to the increase in the number of β receptors, sensitive to catecholamines, so slow to stop, suddenly disabled, can cause tachycardia, aggravate the condition or sudden death.
In short, patients need to have a long-term treatment plan, which is a chronic disease, need patience and time, do not be too hasty, good to comply with the doctor's orders.
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