文档介绍：充血性心衰药物
第一页，共34页。
Concept:
CHF is a complex clinical syndrome characterized by impaired ventricular performance,nts
(V) 舒血管药Vasodilators
(D) 利尿药Diuretics
第十二页，共34页。
pharmacologic intervention in CHF
抗心衰药物是主要用于治疗CHF的药物，主要有强心苷、非甙类正性肌力药、利尿药、ACEI和β受体阻断药等。
Improving hemodynamics with inotropic drugs does not decrease mortality; （病马加鞭）
long-term treatment directed towards neurohormonal factors with ACE inhibitors and beta-blockers can decrease mortality
第十三页，共34页。
Consensus recommendations 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:
水钠潴留：利尿药
ACEIs，ARBs 和/或 beta-blocker
室率快的房颤：强心苷（地高辛）
重症患者延长寿命：醛固酮受体拮抗剂
第十四页，共34页。
fluid retention - a diuretic.
ACE inhibitor and beta-blocker should be initiated and maintained unless specifically contraindicated. （Patients with severe heart failure should probably not receive a beta-blocker）
Digoxin - in patients with rapid atrial fibrillation.
Spironolactone, an aldosterone antagonist, may reduce mortality in patients with severe heart failure
第十五页，共34页。
ACE inhibitors
first-line therapy in all patients with heart failure
improve symptoms, slow progression of the disease, reduce mortality, and decrease the incidence of hospitalization
The most common adverse effects of ACE inhibitors are directly related to lowering angiotensin II concentrations (hypotension and renal insufficiency) and increasing concentrations of kinins (cough and angioneurotic edema)
第十六页，共34页。
血管紧张素原
AngiotensinⅠ
收缩血管
肾素
激肽原
缓激肽↑
降解失活
AngⅢ
ACE
ACEIs
AngⅡ ↓
分泌醛固酮
NO PGI
( - )
ACE和ACEIs作用示意图
舒张血管
第十七页，共34页。
Captopril
第1个在临床上广泛应用的ACEI。含巯基，可致味觉异常。
Enalapril
前体药，不含巯基。药效和作用时间比cartopril强。
第十八页，共34页。
ARBs - angiotensin receptor blockers
angiotensin receptor antagonists (AT1 Receptor Antagonists) are as effective as ACE inhibitors in treating heart fa