Maisch Bernhard, Pankuweit Sabine
Klinik für Innere Medizin - Kardiologie, Philipps-Universität, Marburg und UKGM GmbH, Standort Marburg, Marburg, Germany.
Herz. 2010 Mar;35(2):94-101. doi: 10.1007/s00059-010-3329-z.
The treatment of progressive and terminal heart failure follows the principle of causative therapy. Therefore, etiology and pathophysiology of the underlying disease and its hemodynamic conditions are indispensable. This applies to coronary artery disease, hypertension, valvular heart disease, the cardiomyopathies with and without inflammation, and microbial persistence similarly. The classic treatment algorithms both in heart failure with and without reduced ejection fraction are based on measures onloading the heart (angiotensin-converting enzyme inhibitors, angiotensin antagonists, beta-blockers, diuretics) and on antiarrhythmics and anticoagulation, when needed. Device therapy for cardiac resynchronization in left bundle branch block and permanent stimulation therapy may contribute to the hemodynamic benefit. ICD (implantable cardioverter defibrillator) therapy prevents sudden cardiac death, which is often associated with progressive heart failure. Heart transplantation and left ventricular assist devices are final options in the treatment repertoire of terminal heart failure.
进行性和终末期心力衰竭的治疗遵循病因治疗原则。因此，基础疾病的病因、病理生理学及其血流动力学状况不可或缺。这同样适用于冠状动脉疾病、高血压、心脏瓣膜病、伴或不伴炎症的心肌病以及微生物持续感染。无论射血分数降低与否，经典的心力衰竭治疗算法均基于增强心脏负荷的措施（血管紧张素转换酶抑制剂、血管紧张素拮抗剂、β受体阻滞剂、利尿剂），并在必要时使用抗心律失常药和抗凝药。左束支传导阻滞时的心脏再同步化器械治疗和永久性起搏治疗可能有助于改善血流动力学。植入式心脏复律除颤器（ICD）治疗可预防常与进行性心力衰竭相关的心脏性猝死。心脏移植和左心室辅助装置是终末期心力衰竭治疗方案中的最终选择。
