Ischemic therapeutic tactics _'s treatment in heart failure

Ischemic therapeutic tactics _'s treatment in heart failure
All it involves hearts of cardiac muscle to be or the heart nearly ' Systematicness) The common result of disease, its common cause of disease includes coronary heart disease, essential hypertension, various myocardium diseases and valve disease, diabetes,etc.. Among them coronary artery disease is the important reason in heart failure, ischemic, necrosis of patient's cardiac muscle of coronary heart disease can cause heart failure, it will further cause ischemic, necrosis of the cardiac muscle too that in heart failure at the same time, under many circumstances the two act as the cause and effect of each other.
Ischemic to lead to the fact the mechanism is different different stages of heart failure at coronary heart disease. The patient of angina pectoris usually only has transient ischemic cardiac muscle, heart shrinking and/or relaxation function will be unusual while breaking out in symptom, if the range is more greatly will lead to the fact the sex is in heart failure; But long-term a serious one can cause the intersection of heart and change of structure while being ischemic, left the intersection of room and ejection fraction drop, it is congestive and in heart failure to cause. When myocardium infarction takes place to the patient, the emergence in heart failure correlates with position and quantity of the cardiac muscle of necrosis, if the necrosis cardiac muscle does not exceed 20%, and shrink necrosis of the position for being non- important, then EF is very normal; If exceeds 20%, or involved the important shrink position, then EF drops, it is in heart failure that the patient happens. It in addition have cardiac muscle or person at the time of machineries complication, too can last heart failure mechanisms different. It is usually reversible that the cardiac muscle that the former causes shrinks the function unusually, and the latter often causes the ejection fraction of ventricle to drop suddenly, relaxation of left room is pressed and obviously raised at the end, the patient declines and behaves the serious heart, even heart source shock. After the heart stem or greatly when the range is chronic and ischemic for a long time, because such mechanisms as the ventricle is reinvented cause cardiac dilatation, wall of room to shrink behavior which is short of blood myocardium disease such as incongruous and valve backflow, the ejection fraction of left room drops, it is in heart failure that the difficult managing happens to the patient. In addition, the intersection of coronary heart disease and other clinical situation that patient amalgamate usually, such as essential hypertension, diabetes, old the intersection of regression and the intersection of and valve disease and renal function complete breathing obstacling,etc. by sleep, also will promote or aggravate the emergence that the heart declined. Such as the impact on heart of essential hypertension, the left ventricle is plump in early days, the complying with decline of the cardiac muscle, lead to the fact the relaxation function is not complete, expand the left room gradually for a long time, ejection fraction drops.
Ischemic and in heart failure as the common, important clinical situation, its treatment but lacks clear recommendation in the guide. Have not transported the indication rebuilt and carried on enough description with function to the blood in the relevant guide in heart failure, but blood relevant guide rebuilt to transport decline special crowd this, pay close attention to enoughly to heart. In fact, there are its prominent characteristics in ischemic treatment and prognosis in heart failure, to the treatment of the cause of disease ' The blood is transported and rebuilt) May improve the patient's prognosis, and some, to the drug therapy which ischemic heart declines (block the application of pharmaceutical, ACEI such as receptor) Also decline not the same with the heart of other causes of disease.
As to the thing that ischemic and in heart failure, should be from the proportion of blood supply of coronary artery in the reason causing the heart to decline, coronary artery blood supply cause stage that function change and blood transport rebuild and intensity carry on assessment to the intersection of heart and the intersection of improvement and the intersection of function and three respect of function. In the intersection of cardiac muscle and ischemic patient of heart failure that cause, can until symptom, load test and coronary artery radiography judge the severity which is short of blood, the duration combining symptom appraises the proportion that the blood supply of coronary artery accounts for; Combine medical history, ECG, X-ray, UCG and left room radiography and judge the stage that the heart function changes; As to patient these, blood transport rebuild, improve heart curative effect of function good. Patient of heart failure caused at myocardium necrosis, it can pass position on infarction and from time of infarction ( There is cardiac muscle that restrains the factor at once, has factor that a ventricle reinvents in later period in early days) Judge the blood supply of coronary artery is in the proportion accounted for while taking place in heart failure; Comprehensive medical history, ECG, X-ray, UCG and survive the cardiac muscle judges that judges the stage that the heart function changes; Hibernate cardiac muscle or restrain cardiac muscle,etc. survive the intersection of patient and blood of cardiac muscle transport, rebuild, improve heart function of function better at once more having, wall tumour form and serious valve return to the patient who shed for have machinery complication, room, correct the improvement which contributes to the heart function in operation. As to the ischemic patient at stage of myocardium disease, the prognosis that its heart declines is bad, severity and therapeutic effect of patient's symptom mainly depend on: 1. Survive quantity of the cardiac muscle ' Mainly hibernate myocardiumly) ; 2.The heart dissects and worsens the intensity with the function; 3.The patient's compensation and tolerance.
The ischemic therapeutic principle in heart failure should be a main fact so as not to accuse of the dangerous factor of atherosclerosis, regard resisting the ischemic medicine as basic treatment means, carry on to patient ischemic reasonable application including blood transport rebuild, treat in the comprehensive treatment means inside after the accurate assessment of infarction. Among them the blood is transported to rebuild the therapeutic meaning to depend on the following several respect: 1. Coronary artery blood supply old range have, blood transport benefit great rebuild, on the contrary is relatively small; 2.If the position of the blood supply of coronary artery includes the apex of the heart department or free wall of left room, mainly opposite angle will support, blunt reason will support and the large backside of left room is propped up, the blood is transported to rebuild, benefit greater; 3.Coronary artery narrow intensity serious, base on the premise that the cardiac muscle survives, blood transport benefit loud rebuild, or the blood vessel or seriously narrow blood vessel that the function stopped up such as dissecting; 4.Blood transport rebuild the intersection of range and the intersection of memory and living cardiac muscle, large quantity have, benefit loud. Mainly judge according to including whether there are angina pectoris and symptom, the electric picture of corresponding range heart has R waves, the intersection of coronary artery and radiography, have, to blood flow or better the intersection of side shoot and circulation, low dose of many man of Palestinian phenol amine load UCG can see myocardium sports to strengthen, the cardiac muscle of isotope is apparent like delaying having radioactivity that is being distributed again like pouring into the flawed or damaged district apparently, whether there is FDG that absorbs etc. in pouring into the flawed or damaged district in the myocardium supersession phenomenon. 5.It furthermore helps the heart function to resume that the complete blood is transported and rebuilt, have, survive relevant blood vessel of infarction of the cardiac muscle as to the intersection of blood supply and range, only if advantage right preceded and sharp reason prop up, influence the intersection of heart and blood vessel of function or have, can't carry on blood transport blood vessel that rebuild fill the air to carry blood vessel can consider going on far pathological change Transport the whole blood, rebuild. Transport the way to rebuild as to the blood, because CABG has complete blood that transports and rebuilds the intensity high, with great blood flow volume and can correct advantages such as the machinery complication,etc. at the same time, improve the function of the heart function and is superior to PCI under present following the medical evidence of the card. But PCI little finishing the intersection of operation and necessary time to be short, there are CABG not replacable advantages either in some patients in wound.
In addition have hypertension wait for, promote or aggravate getting ischemic situation that heart declines while being other amalgamating, also need to carry on corresponding intervention. Control blood pressure to that the hypertension patient should be very good, especially blood pressure and morning blood pressure of the peak at night; The diabetic should control blood glucose and monitor regularly through the comprehensive means; Should correct the operation as to the serious valve disease; As to the plump obstructing cardiac muscle Disease
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