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New
Theoretical Preconditions and Apporoaches in Treatment of |
|
N.
Bakradze, M. Gelashvili, Kh. Didebeli,
E.
Tsatsanashvili,
M.
Mangoshvili, |
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During
the
last
decade the
principles
of
treatment
of
the
chronic
cardiac
failure,
have
been
changed
according
to
the
newest
theoretical
preconditions. Medical preparations of a new group and new generation have occurred. The approaches to their prescribing practice have been significantly changed. Their selection is based on the evidence-based medicine, therapy is oriented not only on the heightening of cardiac contractility, but also on the long-term results, such as improvement of the quality of the patients’ lives and increasing of expected living years. All
above mentioned
requires
from
doctors
acquiring
of
deep,
modern
theoretical
knowledge
and
using
of
the
newest
information
in
practice. The
goal
of
given
work
is sharing
of
our
viewpoints,
about
the
schemes
and
conceptual
approaches
prevating
in
the
tactics
and
strategies
of
the
treatment
of
chronic
cardiac
failure
elaborated
by
comparing
of
the
data
existing
in
the
modern
medical
literature
and
our
experience,
to
practicing
physicians. The work based on the results of the treatment rendered to 55-90 years old 242, 167 males and 75 females patients with chronic cardiac failure of different severity developed due to serious cardiac diseases at Tbilisi Clinical Training Hospital for the II World War Veterans in the period of 1992-2002. According to the classification developed by New York Cardiologists Association, 65 patients suffered from chronic cardiac failure of I-II (class), 132 – of III class and 45 – of IV class. In 155 cases chronic cardiac failure was caused by chronic ischemic heart disease. The patients underwent long-term (3-6, and in many cases 9-12 months) combined therapy with inhibitors and beta-blokers of different generations of angiotensin transforming enzymes and diuretics. In cases of insufficient effectiveness in addition glycosides, peripheral vasodilators and aldosteron antagonists were prescribed. Conclusions: 1. According to the present conceptual model of chronic cardiac failure its treatment should be combined and long-term. Medications should administered in reduced dozes (half or less). 2. The strategy and tactics of the treatment of chronic cardiac failure should be elaborated by taking into consideration ethiotropic and pathogenesis mechanisms, parameters of intracardiac and extracardiac hemodynamics, dynamic analysis and assessment of indicators of neuro-endocrine, electrolytic and fluid-electrolyte balance. 3.
The
treatment
of
chronic
cardiac
failure
can
be considered
successful
in
case
if,
in
parallel
to
the
correlation
of
heart
contractility
and
heart
failure,
the
improvement
of
the
quality
of
life
and
prolonging
of
the
average
length
of
life
are achieved. 4.
During
the
recent
decade
correction
of
chronic
cardiac
failure
has
been
significantly
improved
on
the
background
of
discovering
of
new
mechanisms
in
its
pathogenesis.
This
conclusion
clearly
denotes
to
the
existence
of
big
reserves
of
intracardial
and
extracaradiac
mechanisms.
It
creates
future
prospective
in
rationalized
treatment
of
chronic
cardiac
failure.
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| Literature: |
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1. Í.
ÔÀÔÉÛÅÉËÉ. "ÂÖËÉÓ ÖÊÌÀÒÉÓÏÁÉÓ
ÌÊÖÒÍÀËÏÁÀ"
// ÈÁÉËÉÓÉ 1992. |
| Contents |