Management symptomů u pacientů s pokročilým chronickým srdečním selháním
Klíčová slova:
dušnost, chronické srdeční selhání, paliativní péčeAbstrakt
Dušnost patří k základním symptomům srdečního selhání. Základ léčby dušnosti u srdečního
selhání s redukovanou ejekční frakcí v současnosti tvoří blokátory systému renin-angiotenzin,
betablokátory, antagonisté mineralokortikoidních receptorů a inhibitory sodíko-glukózového
kotransportéru 2. Uvedené lékové skupiny mají prokazatelně i prognostický efekt. Za jistých
okolností se k nim řadí ivabradin a nově vericiguat. Symptomatická léčba se opírá především
o diuretika, parenterální substituci železa, v konkrétních případech jsou používána inotropika.
V léčbě refrakterní dušnosti se uplatňují opioidy. Významné místo zastává i přístrojová léčba,
na prvním místě srdeční resynchronizace, u indikovaných pacientů mechanická srdeční podpora.
U pacientů s hypoxémií je indikována léčba kyslíkem. Využití jednotlivých postupů se u konkrétního
pacienta mění s vývojem onemocnění a změnou cílů péče.
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