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治疗心血管病的10个常见误区

2018-05-22 郭艺芳 郭艺芳心前沿

误区一,仅凭心电图T波低平就诊断心肌缺血:很多因素可导致T波的改变,如自主神经功能异常、睡眠障碍、情绪紧张、过度换气、肥胖、电解质紊乱等,心肌缺血只是常见原因之一。

误区一,仅凭心电图T波低平就诊断心肌缺血:很多因素可导致T波的改变,如自主神经功能异常、睡眠障碍、情绪紧张、过度换气、肥胖、电解质紊乱等,心肌缺血只是常见原因之一。若无相关临床症状与体征以及其他辅助检查证据,仅凭T波低平不能诊断冠心病,更不能作为药物治疗的依据;

误区二,无论是否有心绞痛症状,所有冠心病人均服用硝酸酯类药物。确诊冠心病的患者应将他汀、抗血小板药物、b-受体阻滞剂以及ACEI作为基础治疗药物。若无心绞痛症状,无需常规服用硝酸酯类药物。此类药物只能缓解或减少心绞痛发作,不能改善预后;

误区三,心肌梗死心衰病人服用心律平:心肌梗死或心力衰竭患者常合并心律失常,应用心律平虽然能够减少早搏数量,但对预后不利,因此存在明显器质性心脏病的患者不应服用Ic类抗心律失常药。这些患者应该首选b-受体阻滞剂;

误区四,舌下含服心痛定降压:这样做会导致血压短时间内迅速下降,有可能诱发心肌缺血或卒中甚至猝死;

误区五,老年人联合应用b阻滞剂与非二氢吡啶类钙拮抗剂(如地尔硫卓或维拉帕米):这种联合治疗方案虽然不是绝对禁忌,但有可能诱发严重缓慢性心律失常甚至完全性房室传导阻滞,因此不是特别必要时不要联合使用;

误区六,无合并症的高血压患者联合应用ACEI(普利类)或ARB(沙坦类)与b阻滞剂降压治疗:这种联合用药方案对患者并无危害,但降压效果很差,两种药物之间的降压作用不能起到相加作用。如果患者合并冠心病或慢性心衰,这种联合治疗方案是合理的;

误区七,应用西地兰转复房颤:洋地黄类药物只能减慢房颤患者心室率,但无转复房颤的作用。建议选用普罗帕酮或胺碘酮等药物转复房颤;

误区八,房颤患者不做血栓风险评估,不使用抗凝药物:阵发性或持续性房颤患者应常规进行卒中风险评估(如CHADS2评分),必要时予以抗凝药物治疗;

误区九,舒张性心衰患者使用洋地黄:洋地黄会降低心室壁顺应性,可能加重心室舒张功能障碍;

误区十,对合并严重冠心病或心衰的糖尿病患者,过于严格的控制血糖:对于已经发生严重器质性心脏病的患者,一味追求血糖达标弊大于利,故应适当放宽血糖控制目标。

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    2018-05-26 周周人

    学习.

    0

  3. 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  4. 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createdAvatar=https://img.medsci.cn/20200816/e4675a86ea694f12b82202b320dc2654/12f6b900498349e994ce8f516a584d6a.jpg, createdBy=09431951290, createdName=大爰, createdTime=Wed May 23 06:48:36 CST 2018, time=2018-05-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=317689, encodeId=cf7331e68989, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a8f22260741, createdName=121832a9m88暂无昵称, createdTime=Wed May 23 05:45:58 CST 2018, time=2018-05-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=317506, encodeId=e5d131e5067e, content=一起学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/TDiaAWyicHgedzX3wKo3qcxudVJib7AfibfvNeufHRF2jG3Bw8MmZyWjIhtBV1mpJI7Sy9n7RcBKK5t3CuOKuOFxkg/0, createdBy=dd702206933, createdName=wzb521zf, createdTime=Tue May 22 10:58:11 CST 2018, time=2018-05-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=317501, encodeId=c04531e501d2, content=非常好的.谢谢.收藏鉴别诊断很重要, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160718/IMG578C993D395567540.jpg, createdBy=59b81918946, createdName=flysky120, createdTime=Tue May 22 10:42:49 CST 2018, time=2018-05-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=317477, encodeId=bc6f31e47739, content=学习谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Nd44v3xHnnictn9UpctwtH62EPQ59TMdI9lnqHMgQ16nH7GmGCfpzicsHgjibYVk6vwSpXrC86gMibRkoaIzf5HwSz7/0, createdBy=78cc1691107, createdName=龙胆草, createdTime=Tue May 22 08:49:44 CST 2018, time=2018-05-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=317465, encodeId=175f31e46539, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e9572310056, createdName=12225669m29暂无昵称, createdTime=Tue May 22 08:17:58 CST 2018, time=2018-05-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=317412, encodeId=839731e412cf, content=阅, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/fhZdOu27e88Voqh19n8eF8cLplo8L4nicKtH0WnE3KFELXns5XDu8rsiceK2HHDZc2SEStia5VV3Pia2QLMVqlWbHw/0, createdBy=6e012139475, createdName=神功盖世, createdTime=Tue May 22 07:07:48 CST 2018, time=2018-05-22, status=1, ipAttribution=)]
    2018-05-23 大爰

    学习了谢谢分享!!

    0

  5. 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createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/TDiaAWyicHgedzX3wKo3qcxudVJib7AfibfvNeufHRF2jG3Bw8MmZyWjIhtBV1mpJI7Sy9n7RcBKK5t3CuOKuOFxkg/0, createdBy=dd702206933, createdName=wzb521zf, createdTime=Tue May 22 10:58:11 CST 2018, time=2018-05-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=317501, encodeId=c04531e501d2, content=非常好的.谢谢.收藏鉴别诊断很重要, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160718/IMG578C993D395567540.jpg, createdBy=59b81918946, createdName=flysky120, createdTime=Tue May 22 10:42:49 CST 2018, time=2018-05-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=317477, encodeId=bc6f31e47739, content=学习谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Nd44v3xHnnictn9UpctwtH62EPQ59TMdI9lnqHMgQ16nH7GmGCfpzicsHgjibYVk6vwSpXrC86gMibRkoaIzf5HwSz7/0, createdBy=78cc1691107, createdName=龙胆草, createdTime=Tue May 22 08:49:44 CST 2018, time=2018-05-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=317465, encodeId=175f31e46539, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e9572310056, createdName=12225669m29暂无昵称, createdTime=Tue May 22 08:17:58 CST 2018, time=2018-05-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=317412, encodeId=839731e412cf, content=阅, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/fhZdOu27e88Voqh19n8eF8cLplo8L4nicKtH0WnE3KFELXns5XDu8rsiceK2HHDZc2SEStia5VV3Pia2QLMVqlWbHw/0, createdBy=6e012139475, createdName=神功盖世, createdTime=Tue May 22 07:07:48 CST 2018, time=2018-05-22, status=1, ipAttribution=)]
    2018-05-23 121832a9m88暂无昵称

    学习了

    0

  6. 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attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Nd44v3xHnnictn9UpctwtH62EPQ59TMdI9lnqHMgQ16nH7GmGCfpzicsHgjibYVk6vwSpXrC86gMibRkoaIzf5HwSz7/0, createdBy=78cc1691107, createdName=龙胆草, createdTime=Tue May 22 08:49:44 CST 2018, time=2018-05-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=317465, encodeId=175f31e46539, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e9572310056, createdName=12225669m29暂无昵称, createdTime=Tue May 22 08:17:58 CST 2018, time=2018-05-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=317412, encodeId=839731e412cf, content=阅, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/fhZdOu27e88Voqh19n8eF8cLplo8L4nicKtH0WnE3KFELXns5XDu8rsiceK2HHDZc2SEStia5VV3Pia2QLMVqlWbHw/0, createdBy=6e012139475, createdName=神功盖世, createdTime=Tue May 22 07:07:48 CST 2018, time=2018-05-22, status=1, ipAttribution=)]
    2018-05-22 wzb521zf

    一起学习学习

    0

  7. 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attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Nd44v3xHnnictn9UpctwtH62EPQ59TMdI9lnqHMgQ16nH7GmGCfpzicsHgjibYVk6vwSpXrC86gMibRkoaIzf5HwSz7/0, createdBy=78cc1691107, createdName=龙胆草, createdTime=Tue May 22 08:49:44 CST 2018, time=2018-05-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=317465, encodeId=175f31e46539, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e9572310056, createdName=12225669m29暂无昵称, createdTime=Tue May 22 08:17:58 CST 2018, time=2018-05-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=317412, encodeId=839731e412cf, content=阅, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/fhZdOu27e88Voqh19n8eF8cLplo8L4nicKtH0WnE3KFELXns5XDu8rsiceK2HHDZc2SEStia5VV3Pia2QLMVqlWbHw/0, createdBy=6e012139475, createdName=神功盖世, createdTime=Tue May 22 07:07:48 CST 2018, time=2018-05-22, status=1, ipAttribution=)]
    2018-05-22 flysky120

    非常好的.谢谢.收藏鉴别诊断很重要

    0

  8. 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createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/TDiaAWyicHgedzX3wKo3qcxudVJib7AfibfvNeufHRF2jG3Bw8MmZyWjIhtBV1mpJI7Sy9n7RcBKK5t3CuOKuOFxkg/0, createdBy=dd702206933, createdName=wzb521zf, createdTime=Tue May 22 10:58:11 CST 2018, time=2018-05-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=317501, encodeId=c04531e501d2, content=非常好的.谢谢.收藏鉴别诊断很重要, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160718/IMG578C993D395567540.jpg, createdBy=59b81918946, createdName=flysky120, createdTime=Tue May 22 10:42:49 CST 2018, time=2018-05-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=317477, encodeId=bc6f31e47739, content=学习谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Nd44v3xHnnictn9UpctwtH62EPQ59TMdI9lnqHMgQ16nH7GmGCfpzicsHgjibYVk6vwSpXrC86gMibRkoaIzf5HwSz7/0, createdBy=78cc1691107, createdName=龙胆草, createdTime=Tue May 22 08:49:44 CST 2018, time=2018-05-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=317465, encodeId=175f31e46539, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e9572310056, createdName=12225669m29暂无昵称, createdTime=Tue May 22 08:17:58 CST 2018, time=2018-05-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=317412, encodeId=839731e412cf, content=阅, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/fhZdOu27e88Voqh19n8eF8cLplo8L4nicKtH0WnE3KFELXns5XDu8rsiceK2HHDZc2SEStia5VV3Pia2QLMVqlWbHw/0, createdBy=6e012139475, createdName=神功盖世, createdTime=Tue May 22 07:07:48 CST 2018, time=2018-05-22, status=1, ipAttribution=)]
    2018-05-22 龙胆草

    学习谢谢分享

    0

  9. 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    2018-05-22 12225669m29暂无昵称

    学习

    0

  10. 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    2018-05-22 神功盖世

    0

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心血管病一级预防是啥?

调查数据显示,中国心血管病的危险因素呈现明显增长趋势,高血压、高血脂、糖尿病及肥胖的发病率亦有上涨趋势。只有重视心血管病的一级预防,加强对多重危险因素的人群防控,才能使心血管病得到有效控制。小编整理了心血管病一级预防的相关内容,供大家参考。

Hypertension:这两种几亿中国人都有的病,合起来更危险!

近日,中国医学科学院阜外医院李建军教授团队,在美国心脏学会旗下期刊《Hypertension》发表了一项重要的临床研究数据:冠状动脉造影新诊断的稳定性冠心病患者中,单纯的糖尿病前期,并不会导致心血管事件风险升高,而糖尿病前期同时合并高血压时,或者糖尿病同时合并高血压时,则会导致严重冠脉病变事件风险显著升高。

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