Rieger J, Scheler F
Z Gerontol. 1981 Sep-Oct;14(5):403-9.
Cardiac insufficiency in the elderly is not a typically age-induced phenomenon, but is rather due to pathological changes of the heart. Renal function, on the other hand, does show age-related deterioration without any apparent pathological changes occurring. For the treatment of cardiac insufficiency in the elderly three groups of drugs are used: diuretics, cardiac glycosides, and vasodilators. When sinusrhythm is still present diuretics should be primarily employed, and in uneffective glycosides, and finally vasodilators. If hypertension is the main cause of heart failure diuretics and vasodilators should be preferred, and glycosides only used in the last instance. Heart failure complicated by tachyarrhythmia should be treated primarily with glycosides, then diuretics and vasodilators. Powerfully as well as long acting diuretics may cause hypovolaemia, hyponatremia, and in particular hypokalaemia in the elderly. Digoxin accumulates with impaired renal function, Digitoxin is not affected by renal function but its half-life is extremely long. In the case of atherosclerotic changes of the vascular system, vasodilators should be employed with caution to prevent extreme drops in blood pressure.
老年人的心功能不全并非典型的由年龄引起的现象，而是由心脏的病理变化所致。另一方面，肾功能确实会出现与年龄相关的衰退，且无任何明显的病理变化发生。治疗老年人的心功能不全使用三类药物：利尿剂、强心苷和血管扩张剂。当仍存在窦性心律时，应首先使用利尿剂，无效时使用强心苷，最后使用血管扩张剂。如果高血压是心力衰竭的主要原因，应首选利尿剂和血管扩张剂，最后才使用强心苷。并发快速心律失常的心力衰竭应首先用强心苷治疗，然后是利尿剂和血管扩张剂。强效及长效利尿剂可能导致老年人血容量减少、低钠血症，尤其是低钾血症。地高辛会在肾功能受损时蓄积，洋地黄毒苷不受肾功能影响但其半衰期极长。在血管系统发生动脉粥样硬化改变的情况下，使用血管扩张剂时应谨慎，以防血压急剧下降。
