Aronow Wilbert S
Department of Medicine, Cardiology Division, Westchester Medical Center/New York Medical College, Valhalla, NY, USA.
Heart Dis. 2003 Jul-Aug;5(4):279-94. doi: 10.1097/01.hdx.0000080714.87750.48.
American College of Cardiology/American Heart Association class I recommendations for treating patients with heart failure (HF) and abnormal left ventricular ejection fraction are diuretics in patients with fluid retention, an angiotensin-converting enzyme (ACE) inhibitor unless contraindicated, a beta-blocker unless contraindicated, digoxin for the treatment of symptoms of HF, and withdrawal of drugs known to precipitate or aggravate HF such as nonsteroidal anti-inflammatory drugs, calcium channel blockers, and most antiarrhythmic drugs. Class II(a) recommendations for treating HF with abnormal left ventricular ejection fraction are spironolactone in patients with class IV symptoms, preserved renal function, and normal serum potassium; exercise training as an adjunctive approach to improve clinical status in ambulatory patients; an angiotensin receptor blocker in patients who cannot be given an ACE inhibitor because of cough, rash, altered taste sensation, or angioedema; and hydralazine plus nitrates in patients being treated with diuretics, a beta-blocker, and digoxin who cannot be given an ACE inhibitor or an angiotensin receptor blocker because of hypotension or renal insufficiency. Patients with diastolic HF should be treated with cautious use of diuretics and with a beta-blocker. An ACE inhibitor should be added if HF persists or an angiotensin receptor blocker if the patient cannot tolerate an ACE inhibitor because of cough, angioedema, rash, or altered taste sensation. Isosorbide dinitrate plus hydralazine should be added if HF persists. A calcium channel blocker should be added if HF persists. Digoxin should be avoided in diastolic HF if sinus rhythm is present.
美国心脏病学会/美国心脏协会关于治疗心力衰竭(HF)且左心室射血分数异常患者的I类推荐包括:对有液体潴留的患者使用利尿剂;除非有禁忌证,使用血管紧张素转换酶(ACE)抑制剂;除非有禁忌证,使用β受体阻滞剂;使用地高辛治疗HF症状;停用已知会诱发或加重HF的药物,如非甾体抗炎药、钙通道阻滞剂和大多数抗心律失常药物。关于治疗左心室射血分数异常的HF的II(a)类推荐包括:对有IV级症状、肾功能正常且血清钾正常的患者使用螺内酯;运动训练作为辅助方法改善非卧床患者的临床状况;对因咳嗽、皮疹、味觉改变或血管性水肿而不能使用ACE抑制剂的患者使用血管紧张素受体阻滞剂;对正在接受利尿剂、β受体阻滞剂和地高辛治疗,但因低血压或肾功能不全而不能使用ACE抑制剂或血管紧张素受体阻滞剂的患者使用肼屈嗪加硝酸盐。舒张性HF患者应谨慎使用利尿剂并使用β受体阻滞剂进行治疗。如果HF持续存在,应加用ACE抑制剂;如果患者因咳嗽、血管性水肿、皮疹或味觉改变而不能耐受ACE抑制剂,则应加用血管紧张素受体阻滞剂。如果HF持续存在,应加用硝酸异山梨酯加肼屈嗪。如果HF持续存在,应加用钙通道阻滞剂。如果存在窦性心律,舒张性HF患者应避免使用地高辛。