Vinsonneau C, Su J B, Benacerraf S, Darmon M E, Duval-Moulin A M, Crozatier B, Dubois-Randé J L, Castaigne A, Hittinger L
Fédération de cardiologie, hôpital Henri-Mondor, Creteil.
Arch Mal Coeur Vaiss. 1998 Nov;91(11):1315-24.
Therapeutic advances have changed the mode of presentation of cardiac failure over the last decades: the main cause, nowadays, is myocardial ischaemia. The modern treatment of cardiac failure is based on relatively simple physiopathological mechanisms which take into account the different aspects of cardiac physiology: a pump, a muscle, a coronary circulation supplying oxygen to the myocardium, an automatic contraction. The concept of vasodilatation and the blocking of vasoconstrictive systems introduced during the 70s is the basis of modern treatment of cardiac failure which involves angiotensin converting enzyme inhibitors and, increasingly, betablockers. In the near future, with earlier treatment of cardiac failure, the stimulation of vasodilator systems could become a new therapeutic strategy. Early detection of ischaemia and its complications with the aim of limiting the loss of cardiac myocytes is a priority for slowing the progression of cardiac failure. The prevention of cardiac failure also depends on educating cardiologists to treat rapidly the factors predisposing to or prolonging episodes of even mild cardiac failure.
在过去几十年中，治疗进展改变了心力衰竭的表现形式：如今，主要病因是心肌缺血。现代心力衰竭治疗基于相对简单的生理病理机制，这些机制考虑到了心脏生理学的不同方面：一个泵、一块肌肉、为心肌供应氧气的冠状动脉循环、自动收缩。20世纪70年代引入的血管扩张概念和血管收缩系统阻断是现代心力衰竭治疗的基础，这涉及血管紧张素转换酶抑制剂，并且越来越多地涉及β受体阻滞剂。在不久的将来，随着心力衰竭的早期治疗，血管扩张系统的刺激可能成为一种新的治疗策略。早期检测缺血及其并发症以限制心肌细胞损失是减缓心力衰竭进展的优先事项。心力衰竭的预防还取决于教育心脏病专家迅速治疗导致甚至轻度心力衰竭发作的易患因素或延长发作时间的因素。
