Ischemic heart failure.
Ischemic heart failure.
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发表时间：
1995-05
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通讯作者：
J. Ghali
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作者：
J. Ghali
心力衰竭是一个主要的和日益严重的公共卫生问题。冠状动脉疾病已成为心力衰竭的主要病因。对于临床医生来说，区分患有冠状动脉疾病和左心室收缩功能受损的患者的存活心肌和非存活心肌是一个极其重要的问题。几种诊断方法，包括铊显像，多巴酚丁胺负荷超声心动图，正电子发射断层扫描作为检测心肌活力的有用工具已获得相当大的认可。左心室收缩功能保留的心力衰竭的管理包括使用β受体阻滞剂、钙通道阻滞剂和硝酸盐。在心力衰竭和左心室收缩功能受损的患者中，血管紧张素转换酶抑制剂已成为医疗管理的一个组成部分。对于心绞痛对硝酸酯类药物无效的患者，应尝试使用bet阻滞剂，避免使用第一代钙阻滞剂。应始终寻求血运重建，特别是当心肌存活性已确立时。
Heart failure is a major and increasing public health problem. Coronary artery disease has become the major etiology of heart failure. The differentiation of viable from nonviable myocardium in patients with coronary disease and impaired left ventricular systolic function is an issue of extreme importance to the clinician. Several diagnostic modalities including thallium imaging, dobutamine stress echocardiography, and positron emission tomography have gained considerable acceptance as useful tools in detecting myocardial viability. The management of heart failure with preserved left ventricular systolic function includes the use of beta blockers, calcium channel blockers, and nitrates. In patients with heart failure and impaired left ventricular systolic function, angiotensin converting enzyme inhibitors have become an integral part of the medical management. In patients whose angina is unresponsive to the addition of nitrates, a trial of bet blockers should be attempted and first generation calcium blockers should be avoided. Revascularization should always be sought, particularly when myocardial viability has been established.