Author/Editor		Ružič-Medvešček, Nadja
Title		Indikacije za hospitalizacijo bolnika s kroničnim srčnim popuščanjem
Translated title		Indications for hospitalization of patient with congesive heart failure
Type		članek
Source		Zdrav Vars
Vol. and No.		Letnik 40, št. 3-6
Publication year		2001
Volume		str. 160-4
Language		slo
Abstract		Congestive heart failure (CHF) is the main cause of morbidity and mortality in developed countries. It is a syndrome with malignant course. Average mortality of patients with this syndrome amounts to 10% annually. The quality of life is more affect ed than in any other disease. CHF is the most frequent cause of hospitalization in patients over 65 years of age. The number of hospitalizations owing to CHF has increased three times in last decades. Hospitalizations are frequent, long-lasting and reccurent. Causes for hospitalization of patients with CHF are diagnostic procedures, connected with underlying disease, introduction of medicines in risky patients and uncontrollable heart failure. Underlying disease is often diagnosed and defined but sometimes not before ambulatory performed echocardiography. It is of great importance that with this simple procedure it is possible to define the share of systolic and diastolic dysfunction of heart muscle in heart failure. Coronary arteriography is the most frequent diagnostic examination which requests hospitalization of patients under suspicion of coronary disease. The majority of patients can be treated ambulatory, only in risky patients, especially those with diminished systolic function, the ACE inhibitors and beta blockers should be introduced in the hospital. Initial doses of these drugs should be low, but target doses which should be reached, are high. Uncontrollable heart failure is the most frequent cause of hospitalization. It is always necessary to diagnose and treat resp. supress trigger factors, among which the most frequent are: excessive intake of salt and water, myocardial ischemia, unstable arterial hypertension and arrhythmias. Seriously affected patients are treated by sequential diuretic therapy, increasing doses of ACE inhibitors, antiarrhythmic agents and, if necessary, with inotropic drugs and vasodilators in the hospital. (Abstract truncated at 2000 characters)
Summary		Kronično srčno popuščanje (KSP) je glavni vzrok obolevnosti in umrljivosti v razvitih deželah. KSP je sindrom, ki poteka maligno. Povprečna letna umrljivost bolnikov s tem sindromom je 10%. Kakovost življenja je bolj okrnjena kot pri kateri koli drugi bolezni. KSP je najpogostejši vzrok hospitalizacije pri bolnikih, starejših od 65 let V zadnjih desetletjih se je število hospitalizacij zaradi KSP trikrat povečalo. Hospitalizacije zaradi KSP so pogoste, dolge in se ponavljajo. Vzroki za hospitalizacijo bolnikov s KSP so diagnostični postopki v zvezi z osnovno boleznijo, uvajanje zdravil pri ogroženih bolnikih in neobvladljivo srčno popuščanje. Osnovno bolezen pogosto potrdimo, natančno opredelimo, včasih pa šele odkrijemo z ehokardiografijo, ki je izvedljiva ambulantno. Zelo pomembno je, da lahko s to enostavno preiskavo opredelimo delež sistolične in diastolične disfunkcije srčne mišice pri srčnem popuščanju. Najpogostejša diagnostična preiskava, zaradi katere bolnike hospitaliziramo, je koronarografija. Potrebna je pri bolnikih, kjer sumimo na koronarno bolezen. Večini bolnikov s KSP lahko uvedemo zdravljenje ambulantno, le ogroženim bolnikom, predvsem tistim z okrnjeno sistolično funkcijo, uvajamo zaviralce ACE in blokatorje beta v bolnišnici. Začetni odmerki teh zdravil morajo biti majhni, ciljni odmerki, ki jih moramo doseči, pa so veliki. Neobvladljivo srčno popuščanje je najpogostejši vzrok hospitalizacije. Vedno moramo odkriti in zdraviti oz. odpraviti sprožilne dejavnike, med katerimi so najpogostejši čezmerno uživanje soli in vode, ishemija miokarda, neurejena arterijska hipertenzija in aritmije. V bolnišnici zdravimo hudo prizadete bolnike s sekvenčno diuretično terapijo, večamo odmerke zaviralcev ACE, zdravimo aritmije, po potrebi posežemo po inotropnih in vazodilatacijskih zdravilih. V skrajnem primeru, če so pogoji, se odločimo za transplantacijo srca.
Descriptors		HEART FAILURE, CONGESTIVE HOSPITALIZATION