John. J. V. McMurray

Documento de Consenso de Expertos sobre bloqueadores de los receptores β-adrenérgicos

Rev Esp Cardiol. 2005;58(1):65-90 65 ÍNDICE DE CONTENIDOS Preámbulo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 Clases de recomendaciones . . . . . . . . . . . . . . . . . . . 66 Grados de evidencia . . . . . . . . . . . . . . . . . . . . . . . . . 66 Introducción . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 Farmacología. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 Definición . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 Clasificación de los bloqueadores beta . . . . . . . . . 67 Propiedades farmacocinéticas . . . . . . . . . . . . . . . . 68 Fármacos lipofílicos . . . . . . . . . . . . . . . . . . . . . 68 Fármacos hidrofílicos . . . . . . . . . . . . . . . . . . . . 68 Fármacos de eliminación equilibrada . . . . . . . . 68 Mecanismo de acción . . . . . . . . . . . . . . . . . . . . . . 69 Efectos adversos . . . . . . . . . . . . . . . . . . . . . . . . . . 69 Cardiovasculares . . . . . . . . . . . . . . . . . . . . . . . 69 Metabólicos . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 Pulmonares . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 Sobre el sistema nervioso central . . . . . . . . . . . 70 Disfunción sexual . . . . . . . . . . . . . . . . . . . . . . . 70 Contraindicaciones . . . . . . . . . . . . . . . . . . . . . . . . 70 Interacciones medicamentosas . . . . . . . . . . . . . . . 70 Dosificación de los bloqueadores beta . . . . . . . . . 70 ART Í C U L O S ES P E C I A L E S

Documento de Consenso de Expertos sobre el uso de inhibidores de la enzima de conversión de la angiotensina en la enfermedad cardiovascular

Preámbulo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1213 Clases de recomendaciones . . . . . . . . . . . . . . . . . 1214 Grados de evidencia . . . . . . . . . . . . . . . . . . . . . . . 1214 Introducción . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1214 Farmacología . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1215 Definición. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1215 Clasificación de los IECA . . . . . . . . . . . . . . . . 1216 Perfil farmacocinético . . . . . . . . . . . . . . . . . . . 1216 Mecanismo de acción. . . . . . . . . . . . . . . . . . . . 1216 Efectos de los IECA. . . . . . . . . . . . . . . . . . . . . 1217 Efectos hemodinámicos . . . . . . . . . . . . . . . . 1217 Efectos neurohormonales . . . . . . . . . . . . . . . 1217 Efectos antiproliferativos . . . . . . . . . . . . . . . 1217 Efectos renales . . . . . . . . . . . . . . . . . . . . . . . 1217 Otros efectos. . . . . . . . . . . . . . . . . . . . . . . . . 1218 Efectos en el equilibrio fibrinolítico . . . . . . 1218 Efectos colaterales . . . . . . . . . . . . . . . . . . . . . . 1218

Return to work following first hospitalization for heart failure

Recent trends in diagnostic work-up among unselected patients newly diagnosed with heart failure : a Swedish population-based studyMitral regurgitation severity correlates with symptoms and extent of left atrial dysfunction : effect of mitral valve repairHeart failure can occur in any age, no depend on sex, but in men and women the mechanism, even if is the same, the fact is that the compromise on pumping function is diferent. AIM We realized a follow-up with 100 female patients during hospitalization with heart failure as a mean diagnostic. These are patient between 60 and 75 years old, with different pathologies: diabetes mellitus, arterial hypertension, obesity, atrial fibrillation, and hypothyroidism. We observed their treatment comparing with a control group (100 men in heart failure) by administering vasodilator and diuretic drugs. Performed echocadiography doppler control, daily renal function, NT pro BNP levels control, oxide nitric response. Results: We observed that ventricular dilation, hypertrophy as tachycardia is more typical in men. Our group demonstrated very fast response to beta blockers and diuretics. The ejection fraction increased in 10-15% faster than in control group. Oxide nitric had not the result we expected. But in men the effect is very high. NT pro BNP levels no were increased as a control group. Recovering renal function in women during heart failure depends on risk factors as diabetes mellitus, obesity, more characteristics for women. Conclusions: In women heart failure has the same mechanism that in men, but more of the cardiac compensatory mechanisms during heart failure as Frank-Starling mechanism, ventricular dilation or hypertrophy and tachycardia present more complications in men; women recover sinus rhythm faster than men, hypertrophy is not characteristic and dilation recovers EF as pumping function is near normal. We do not observed increased sympathetic adrenergic activity in our patients and increased vagal activity to heart. Renin-angiotensin-aldosterone and antidiuretic hormone systems in women is compensated by vasoconstriction improving ventricular stroke volume by reducing afterload on the ventricle. Table 3. NT-pro BN characteristics NT-proBNP cutoff value of 125 pg/mL had the best sensitivity-to-specificity ratio and NPV to rule out asymptomatic LV moderate to severe diastolic or systolic dysfunction in patients at risk for heart failure: 1. Men younger than 60 years (sensitivity, 87.5%; specificity, 92.7%; NPV, 99.5%; positive predictive value [PPV], 33.3%) 2. Women younger than 60 years (sensitivity, 100%; specificity, 84.1%; NPV, 100%; PPV, 33.3%) 3. Men at least age 60 years (sensitivity, 100%; specificity, 77.1%; NPV, 100%; PPV, 32.5%) 4. Women at least age 60 years (sensitivity, 100%; specificity, 69.9%; NPV, 100%; PPV, 21%)