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CARDIOLOGY

CARDIOLOGY

Large Domestic Population Study: Exploring the Status of Secondary Prevention of Cardiovascular Disease in China

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Cardiovascular disease (CVD), especially ischemic heart disease (IHD) and ischemic stroke (IS), is the leading cause of death for our residents.Cardiovascular disease secondary prevention therapies, such as aspirin, beta-blockers, angiotensin-converting enzyme inhibitors (ACEIs), and statins, can reduce cardiovascular disease mortality.Therefore, ensuring widespread use of secondary prevention therapies is critical to reducing the burden of CVD in China.Recently, a study published in the journal HEART reported the current use of secondary preventive drugs in patients with IHD and / or IS in the Chinese community.
Research Methodology Based on the Chinese Patient-Centric Cardiac Event Million Person Assessment Project, which selected 2,613,035 ages in 35,857 communities in 31 provinces in mainland China from September 2014 to November 2018-Participants between the ages of 75.Researchers measured blood pressure, lipids, blood sugar, height, and weight for each participant.Hypertension is defined as systolic blood pressure ≥140 mmHg, diastolic blood pressure ≥90 mmHg or use of antihypertensive drugs.Normal weight is defined as 18.5 ≤ BMI ≤ 23.9 kg / m2, low weight is defined as BMI <18.5 kg / m2, overweight is defined as 24.0 ≤ BMI ≤ 27.9 kg / m2, and obesity is defined as BMI ≥ 28.0 kg / m2.Standardized face-to-face interviews were conducted by trained personnel to gather relevant information about participants, their IHD or IS medical history, and medication use.The researchers used the Cloper-Pearson method to describe the overall and population subgroups (such as age, gender, and degree of urbanization) to determine the use of antiplatelet drugs or statins, and used a multivariate mixture model and logit-linkThe association between individual characteristics and secondary preventive drug use was assessed.Among the 2,613,035 participants, 2.9% (74,830) reported a history of IHD and / or IS, and the use of antiplatelet or statin drugs was 34.2% (Table 1).IHD patients use secondary prevention drugs more than IS patients (the ratio of either of the two drugs is 40.4% and 29.0%, the proportion of antiplatelet drugs is 37.4% and 26.6%, and the statins are 14.6% And 8.2%, the proportion of both drugs is 11.6% and 5.8%).The use of secondary preventive drugs increased with age (from 19.2% at 35-39 years to 37.3% at 70-75 years, p <0.001).Men used secondary prevention drugs more often than women (37.9% vs 30.4%, p <0.001).The use of antiplatelet drugs or statins was higher in urban areas than in rural areas (35.9% vs 32.9%, p <0.001).The proportion of patients with higher education levels and family income who used secondary preventive drugs was slightly higher (p <0.001).The proportion of patients with medical insurance using drugs was slightly higher than without medical insurance, but the difference was not statistically significant (34.3% vs 29.1%, p = 0.07).Patients with a previous history of hypertension (39.1% vs 28.7%, p <0.001) or diabetes (41.1% vs 32.7%, p <0.001) had significantly higher drug use rates.Patients diagnosed with CVD within 2 years (34.9%) had slightly higher drug use than patients diagnosed 2 years or earlier (33.7% in 2-7 years; 33.8% in> 7 years, p = 0.07).In a subgroup of 1,530,408 patients, defined by all possible permutations of 16 individual characteristics, the use of secondary preventive drugs varied widely (8.4% –60.6%).Multivariate analysis showed that the use of secondary prevention drugs was lower in patients who were younger, women, smokers, drinkers, had no history of hypertension or diabetes, and had been diagnosed with CVD for more than 2 years.
Conclusion In summary, in IHD and / or IS patients, about one-third of patients take antiplatelet or statins, and 1 in 12 patients take both drugs at the same time.The use of antiplatelet drugs and statins is low in all subgroups, especially among younger, female, educated, or low-income families.Improving the level of secondary prevention of cardiovascular disease in China requires scalable, targeted, and effective interventions.The above content is only authorized for exclusive use by 39Health.com, please do not reprint without the authorization of the copyright party.

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CARDIOLOGY

Is your home fat during epidemic prevention?

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I was separated for a month at home, finished eating two boxes of snacks, gained 1 cm of hair, and gained 3 kg of weight … For most people, vacation means eating, drinking and drinking at home, and office workers who have already started working from homeIt also fulfilled the dream of “making money by lying down”, and operated the computer in bed to complete daily work.The problem also comes. In a month of sedentary and inactive exercise, your cardiovascular risk may have quietly increased.14 hours of sleep, 10 hours of sitting, can there be “saving”?The relationship between sleep, sedentary and cardiovascular disease risk has always been the focus of attention.So what is sedentary in the end, and how to reduce sedentary damage to the body?A large study from Australia defined sedentary behavior as sitting more than 6 hours per day.The study included more than 260,000 samples and found that the damage caused by sedentary is difficult to reverse.What we used to think of as “seat by standing” has little effect on reducing the harm of sedentary.The researchers said that the method of sitting instead of sitting has only a slight benefit for people who are not sitting for a long time, but it is not useful for people who are sedentary.Sitting instead of sitting is not effective, you can only move!Once you start the sedentary lifestyle, all you can do to save you is exercise.Researchers said that performing 1-hour moderate-intensity aerobic exercise can reduce the risk of cardiovascular disease death by about 20%, but it has basically not reduced the risk of all-cause death.While walking is the “opposite”, it can reduce the risk of all-cause death by about 20%, but has no significant effect on the risk of cardiovascular death.And strenuous exercise can reduce the risk of all-cause death by about 30% and the risk of cardiovascular death by about 60%.From this point of view, to reduce the harm of sedentary, we can maintain one hour of vigorous exercise per day, or one hour of moderate intensity exercise combined with walking.Of course, the most direct and effective way to reduce the harm caused by sedentary is: don’t sit long!39health.net (www.39.net) original content, can not be reproduced without authorization, offenders must be investigated.For content cooperation, please contact: 0000 or 0000

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CARDIOLOGY

Professor Tian Gang: During the epidemic, patients with hypertension should strengthen self-management

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Among patients with new coronavirus infection, hypertension is the most common comorbid disease, and the proportion of severe patients with hypertension is significantly higher than that of non-severe patients [1].Therefore, during the epidemic period, patients with hypertension should reduce going out and seek medical treatment. This requires patients to manage their blood pressure well to avoid serious cardiovascular events during inconvenient medical treatment.
New Coronary Pneumonia Combined with Hypertension Proportion On February 9, Zhong Nanshan published on medRxiv a study of 1099 patients with new type of coronavirus infection in 522 hospitals in 31 provinces across the country, which showed that 23.2% of patients were associated with underlying diseases.The highest proportion, accounting for 14.9% of the total population [2].Self-management of blood pressure patients 1 Persistent medication, regular home self-measuring blood pressure medication is an important means to control blood pressure. There are five major classes of antihypertensive drugs, including calcium channel blockers (CCB), angiotensin converting enzyme inhibitors (ACEI)), Angiotensin receptor antagonist (ARB), diuretics, beta blockers.Individualized treatment should be selected according to the type of special population and comorbidities (Table 1) [3].During the epidemic, the Chinese Centers for Disease Control and Prevention advised patients with hypertension to follow the doctor’s advice to comply with treatment, prepare medications, take medicines in sufficient quantities on time, and do not change or discontinue the medicines themselves [4].Evidence shows that compared with poor drug compliance, high compliance can increase the blood pressure control rate by 33% [5], and reduce the risk of cardiovascular events by 55%, the risk of ischemic heart disease by 55%, and stroke/ TIA risk reduction by 56% and heart failure risk by 46% [6].In order to ensure the long-term medication needs of chronically ill patients, the National Medical Insurance Bureau issued a notice: during the epidemic period, a “long prescription” reimbursement policy was implemented. For patients with chronic diseases such as hypertension and diabetes, the doctors at the treating hospitals were evaluated to support the relaxation of the prescription medication to 3Month [7].In addition, home blood pressure monitoring can help increase patients’ awareness of health participation, improve patient compliance, and assist in adjusting treatment options [3].During the epidemic and inconvenient medical treatment, home blood pressure monitoring is helpful for timely understanding of blood pressure control and whether there is too high or too low blood pressure. You can contact the doctor to adjust the treatment plan or respond in time to avoid cardiovascular or other adverse effects.event.During home blood pressure monitoring, blood pressure should be measured in the morning and evening every day, and pay attention to [8]: Each measurement should be taken in the sitting position after 5 minutes of rest, and measured 2-3 times, with an interval of 1 minute; In the morning, within 1 hour of getting up, take a dropBefore pressing medicine, and before breakfast and strenuous exercise; Evening measurement after dinner and before going to bed; Newly diagnosed patients, early treatment or patients who have not yet reached the standard blood pressure, should be continuously measured for 5-7 days before consultation; Blood pressure controlWhen in good condition, measure at least 1 d per week. When the average family blood pressure is ≥135 / 85 mmHg, the diagnosis of hypertension can be confirmed, or the blood pressure has not been controlled.If the family self-tests the blood pressure and finds that the blood pressure rises, it is necessary to consider whether it is caused by anxiety or nervousness. The blood pressure may be measured intermittently, such as 1-2 times / every other day.If the blood pressure control is still indicated repeatedly, you can consider adjusting the medication through online medical consultation during the epidemic, if necessary, visit the clinic, pay attention to protection.2 Maintaining healthy lifestyle habits Lifestyle interventions are a reasonable and effective treatment for any patient with hypertension at all times. Therefore, healthy lifestyle habits should also be maintained during the epidemic.Including salt restriction (<6 g daily), reasonable nutrition, moderate exercise and other healthy lifestyles (quit smoking, alcohol restriction, regular work and rest, and adequate sleep) [4].Among them, in order to ensure reasonable nutrition, such as adding whole grains and potato foods (150-400 g), ensuring sufficient fruits (200 g) and vegetables (400-500 g) [4], patients or family members will inevitably go out to purchase, soProtect yourself when going out, such as wearing medical surgical or N95 masks, and maintain hand hygiene, reduce contact with items or parts in public places, avoid touching the nose and mouth, and wash your hands with hand sanitizer or soap under running water after returning [9].You can also choose to buy online for non-contact delivery and reception. Pay attention to hand washing and disinfection after receipt.In addition, try to stay at home during the epidemic, such as outdoor sports, and avoid contact with the crowd.Low- and medium-intensity aerobic exercise is the main, 3-5 times a week, each 20-30 minutes.Avoid large changes in body position and anaerobic exercise.If there is a significant increase in blood pressure or patients with heart failure, unstable angina pectoris, retinal hemorrhage, severe arrhythmia, etc., temporarily do not exercise [4].3 Relieve mental stress and maintain psychological balance Epidemic situation At present, patients with hypertension will inevitably become nervous and produce anxiety, which can activate sympathetic nerves and increase blood pressure [3].Studies have shown that anxiety and depression are associated with higher blood pressure levels [10].Therefore, patients with hypertension need to correctly treat the epidemic situation, pay attention but not nervous, and choose a suitable entertainment method to relax. [4]4 Attention to assess the cardiovascular risk of patients with diabetes and / or dyslipidemia Compared with patients with simple hypertension, combined with diabetes and / or dyslipidemia further increases the risk of cardiovascular disease (Table 2) [11].Therefore, special attention should be paid to the assessment of cardiovascular risk in such patients.When necessary, primary prevention should be considered. In addition to lifestyle interventions and blood pressure monitoring and control for patients with hypertension, monitoring and control of blood lipids and blood glucose should be performed [12].In addition, at the age of 40-70, the 10-year expected risk of ASCVD at the initial risk assessment is ≥ 10%, and there are still ≥ 3 major risk factors that are poorly controlled or difficult to change after active treatment interventions (such as a family history of early-onset cardiovascular disease)) Patients may consider aspirin for primary prevention [13].To avoid serious cardiovascular events during the outbreak and inconvenient visits.. Summary Hypertension is the most common comorbid condition in patients with new coronary pneumonia and exacerbates it.During the epidemic, patients with hypertension should strengthen self-management of blood pressure.For patients with diabetes and / or dyslipidemia, attention should be paid to cardiovascular risk assessment, and primary prevention strategies should be adopted if necessary to prevent cardiovascular events.The above content is only authorized for exclusive use by 39Health.com, please do not reprint without the authorization of the copyright party.

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CARDIOLOGY

Afraid of new crown pneumonia?

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From the beginning of 2020, the suddenness, unpredictability and severity of new coronary pneumonia have added a gray shadow to China and the world.As early as January 23, the National Health and Health Commission released 17 death data. Among them, the minimum age of the deceased is 48 years old, 78.9% of the elderly are over 60 years old, and most of the deaths are elderly people.
In addition, most of the 17 deaths were patients with chronic diseases before being infected with the new coronavirus pneumonia, such as chronic diseases such as hypertension, coronary heart disease, diabetes, and cerebral infarction.Jiao Yahui, deputy director of the State Administration of Health and Medical Administration, told a news conference that the main causes of death of patients are old age and chronic diseases, and more than 75% of deaths have one or more chronic diseases, such as cardiovascular and cerebrovascular diseases., Diabetes, tumors and other basic diseases.Elderly people with underlying diseases have a high case fatality rate as long as they are infected with pneumonia (not pneumonia due to the new coronavirus infection).According to the statistics of “China Cardiovascular Diseases Report 2018”, the current number of cardiovascular disease patients is 290 million, and the mortality rate of cardiovascular disease is still the highest, higher than that of tumors and other diseases. Two out of every five deaths die from the heart.Vascular disease [1].With the increase of age, the structure and function of the heart (enlarged heart, thickened ventricular septum, and diastolic function) will have certain changes. Previous studies have found that cardiovascular risk factors such as hypertension and diabetes in the heart structure and function of elderly patientsChanges also play an important role [2].As a stressor, neocoronary pneumonia may over-activate the sympathetic system. The catecholamine-related effects of hypersympathosis will increase the patient’s heart rate, increase myocardial oxygen consumption, instability of vascular plaques, and further increase myocardial damage, making heart functionFurther decline, its harm is self-evident.Therefore, elderly patients with cardiovascular disease are one of the groups that are easily attacked by the new coronavirus or other pathogens, and effective prevention measures should be done in time to avoid the risk of infection.01 Reasonable medication, choose better treatment medications. Clear medication indications. When giving medications to the elderly, medication indications must be clarified to reduce the number of medications and drugs with strong nephrotoxicity. Formulate a reasonable medication regimen. The medication regimen should be as simple as possible.To avoid drug abuse, it is advisable to use no more than 4 types of combined drugs [3].For example, in the treatment of hypertension with coronary heart disease, calcium antagonist (CCB) dilates blood vessels to counteract the vasoconstrictive effect of beta blockers; while beta blockers slow the heart rate effect to counteract CCB reflex sympathetic excitement.Increased heart rate.β-blocker combined with CCB treatment not only has a significant antihypertensive effect, but also reduces the corresponding adverse reactions. Therefore, the combined application of the two is an optimal solution for patients with hypertension and coronary heart disease.[4].▎ Pay attention to individual differences in the treatment of elderly people with individualized medicines. Their general health status, concurrent diseases, disease severity, disease course, and disease development process are different. Therefore, the principle of individualization should be followed when formulating treatment plans for patients.Blind treatment cannot be performed in accordance with standard treatment methods.In particular, the choice of drug dose should be accurately calculated according to the patient’s weight, age, and physical fitness—usually increasing from small doses, and the elderly dosage—usually 0.5-0.75 times that of adults, and based on the patient’s renal functionIndividual adjustment, if possible, blood concentration monitoring can be performed [5].▎Guaranteeing medication compliance In addition, elderly patients with cardiovascular disease are unable to take medications on time, for a full course of treatment, and in sufficient quantities due to the variety of medications, large amounts, frequent medications, memory loss, and insufficient knowledge of medications, which leads to patient compliancePoor, can not guarantee the clinical results achieved by drug treatment programs.Therefore, after formulating a reasonable drug treatment plan according to the actual situation of the patient, the clinician should also provide health education to the patient and his family, so that the patient and their family can clearly and accurately recognize the necessity and importance of medication according to the doctor’s order, and reduce the patient’s own claimsReduce the probability of missed doses, missed doses, or discontinuation of medications, establish medication files for patients, follow up patients regularly, and urge patients to use medications reasonably [6].02 Learn to self-manage and do a good job of disease monitoring. Regularly monitor blood pressure, heart rate, blood sugar, and weight every day to understand the control of the disease.Work and rest.Appropriate exercise helps to ensure the stability of the elderly patients with cardiovascular disease, but not excessive exercise.In the case of “do not go out”, exercise is generally based on walking and bedside cycling, not too fast, too early and too late.Helps maintain or improve cardiopulmonary function, enhances physical fitness, and improves immunity.Quit smoking.Smoking can increase the risk of various cardiovascular diseases; the risk of disease after smoking cessation is reduced.Smoking can cause vasomotor dysfunction, vascular endothelial dysfunction, and cause atherosclerotic plaque instability, which can easily cause the formation of thrombus.Therefore, patients with cardiovascular disease must first quit smoking before drug treatment [7].Reasonable meal.Controlling total calories, a balanced diet, and limiting the intake of salt and food added sugar can reduce cardiovascular disease risk factors or reduce the incidence of cardiovascular disease has become a consensus, and has been clarified by dietary guidelines and cardiovascular disease prevention guidelines for residents in China and foreign countriesRecommended [8]..
Control emotion.The frequent recurrence of negative emotions causes long-term or excessive nervous tension, which can cause body diseases, such as neurological dysfunction, endocrine disorders, increased blood pressure, etc., and thus transform into diseases of certain organs and systems, affecting the treatment of elderly patients with cardiovascular disease.Effect [9].In short, in this epidemic, elderly patients with cardiovascular disease should pay attention to avoiding viral infections and not panic too much. While doing a variety of preventive measures, learn to self-administer, self-monitor, and follow the doctor’s advice to use medicines on time and standard.I believe the epidemic will pass soon!39health.net (www.39.net) original content, can not be reproduced without authorization, offenders must be investigated.For content cooperation, please contact: 0000 or 0000

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CARDIOLOGY

What do clinicians need to know about new coronavirus infections, ACE inhibitors, and ARB treatment?

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The outbreak of new coronavirus (SARS-CoV-2) infection has occurred in Wuhan and Hubei provinces at the end of 2019. It currently affects the whole country and even overseas, causing serious concern of the medical community and the people throughout the country and the great attention of governments and the World Health Organization.Chinese virologists took the lead in confirming that both SARS-CoV-2 and SARS viruses are coronaviruses, and they have greater homology.
According to the results of previous studies on SARS virus, it is speculated that the pathogenesis of SARS-CoV-2 infection is likely to be similar to SARS virus. Published laboratory research results suggest that SARS virus infection and its lung damage and lung tissueAngiotensin-converting enzyme 2 (ACE2) is involved.In the Renin-Angiotensin System (RAS), ACE and ACE2 are vital central links to maintain hemodynamic stability and normal heart and kidney function in the body.A large body of evidence-based medical evidence shows that in patients with hypertension, diabetes, coronary heart disease, heart failure and chronic kidney disease, ACE inhibitors and / or angiotensinBasic treatment for the risk of renal adverse events, quality of life, and longevity.So, in the current environment of SARS-CoV-2 infection, how to consider ACE inhibitor / ARB treatment?1 Physiology of ACE and ACE2 ACE and ACE2 are widely distributed in the human body. The former mainly exists in the lung, kidney, heart, and vascular tissues; the latter exists more in the digestive tract, lung, kidney, heart, and blood vessels.Strictly speaking, ACE2 is not an isoenzyme of ACE, but only a homolog of ACE.As shown in the figure, renin hydrolyzes angiotensinogen to angiotensin I (Ang I), which is then converted into Ang II by ACE. Ang II binds to angiotensin receptor 1 (AT1R) on the vascular smooth muscle cell membrane.Causes a series of effects including vasoconstriction and vascular remodeling.ACE2 can hydrolyze Ang I to inactive Ang 1-9 (Ang 1-9 can also be hydrolyzed to Ang 1-7 by ACE), and it can also hydrolyze Ang II to Ang 1-7.ACE2 can hydrolyze Ang II into Ang 1-7. Ang 1-7 can act on MAS receptors and mediate a series of cardiovascular protective effects such as diastolic blood vessels, anti-cellular proliferation, anti-oxidative stress, and delay or reverse vascular remodeling..It can be seen that the ACE-Ang II-AT1R axis and the ACE2-Ang 1-7-Mas axis balance each other in the body to keep the body environment stable.research shows.ACE2 hydrolyzes Ang II 400 times more efficiently than Ang I.Some studies suggest that Ang I accumulation and elevated levels under the treatment of ACE inhibitors may increase the expression and activity of ACE2 as a substrate; after ARB treatment, both Ang I and Ang II may be increased, thus inducing the expression and activity of ACE2 to be up-regulated..Studies have also suggested that ACE2 expression and activity are reduced after treatment with ACE inhibitors or ARBs.2 ACE2 and coronavirus pneumonia laboratory studies suggest that RAS plays an important role in the pathophysiology of viral pneumonia-related acute respiratory distress syndrome (ARDS).In patients with ARDS infected with avian influenza H7N9 virus, plasma Ang Ⅱ level may be an important indicator of early warning prognosis.Elevated plasma Ang Ⅱ levels are associated with disease severity, and Ang Ⅱ levels at week 2 of ARDS predict disease prognosis.In mice infected with SARS virus and SARS spike protein, lung ACE2 expression decreased significantly, suggesting that the decrease in ACE2 expression level plays an important role in the pathological process and disease progression of acute progressive respiratory failure / ARDS caused by SARS virus infection.Regardless of acid inhalation, endotoxin or sepsis or H5N1, H7N9-induced ALI / ARDS mouse models, the ACE-AngII-AT1R axis may promote lung injury, while ACE2 shows protective effects on lung function.Recently, Chinese doctors and scientists have published a clinical research report entitled “Research on Clinical and Biochemical Indicators Related to Lung Injury in New Coronavirus (2019-nCoV) Infected Patients” in the journal “Science and Life Sciences of China”.2 Twelve patients at the early stage of infection were prospectively observed and found that all 12 patients progressed to pneumonia, and half of them became ARDS.The SARS-CoV-2 titer detected from the patient’s respiratory tract, especially the lower respiratory tract, was positively correlated with the severity of lung disease.Hypoalbuminemia, lymphocyte count, lymphocyte percentage (%), lactate dehydrogenase activity, neutrophil percentage (%), and C-reactive protein levels and the extent of acute lung injury after SARS-CoV-2 infectionHighly correlated.Age, SARS-CoV-2 virus titer, lung injury score, and blood biochemical indicators may be predictors of disease severity.Plasma Ang II levels in patients with pneumonia and healthy controls caused by SARS-CoV-2 were detected, and the plasma Ang II levels were significantly higher than those in healthy controls. Ang II levels were linearly correlated with viral titers and lung injury.This result suggests that SARS-CoV-2 infection may cause RAS imbalance in patients.In addition to coronavirus directly causing lung tissue damage, a series of studies have suggested that severe inflammation may be triggered (cytokine storm) after 2-4 weeks after coronavirus infection, causing severe damage to lung tissue and aggravating lung function, leadingRespiratory distress syndrome and respiratory-circulatory failure.Recent experimental studies suggest that treatment with ACE inhibitors can significantly reduce pulmonary inflammation and cytokine release caused by coronavirus infection.In related research on SARS virus infection, it was found that by combining with the Spike glycoprotein group of ACE2 on the cell membrane of lung tissue, SARS virus can enter the cell in the form of endocytosis of ACE2-SARS fusion particle cells.Therefore, ACE2 is an essential receptor for SARS virus infection.In vitro studies show that the Spike glycoprotein of ACE2 is closely related to its activity. When the expression of Spike protein is reduced, the activity of ACE2 is significantly reduced.Therefore, SARS virus infection leads to a decrease in ACE2 expression and its activity, which may be a pathophysiological mechanism of severe lung failure caused by SARS virus.Therefore, from the currently available laboratory data, it is speculated that the expression / activity level of ACE2 may be positively correlated with the risk of coronavirus infection and negatively correlated with the degree of lung damage after coronavirus infection.3 ACE inhibitors, ARB treatments and expression of ACE2 and changes in their activity A large amount of evidence-based medical evidence shows that in patients with hypertension, diabetes, coronary heart disease, heart failure and chronic kidney disease, ACE inhibitors and / or ARB drugs are effectiveBlood pressure and maintain blood pressure stable, long-term treatment can significantly reduce the risk of cardiovascular, cerebrovascular and renal adverse events, improve quality of life, and extend patient life.Multiple real-world studies have shown that adherence to long-term adherence to ACE inhibitors and / or ARB treatments to a large extent determines patients’ cardiovascular outcomes and the risk of all-cause death.Therefore, all cardiovascular disease prevention and treatment guidelines recommend ACE inhibitors and ARBs as basic treatment drugs, and include clinical treatment plans for patients with hypertension, diabetes, and cardiovascular and kidney diseases.Some laboratory research results suggest that after treatment with ACE inhibitors, the level of Ang I in the body increases, ACE 2 hydrolyzes Ang I to generate Ang 1-9, and is subsequently converted by ACE to Ang 1-7, which may help cardiovascular andKidney protection.After ARB treatment, Ang I and Ang II, which are substrates of ACE2, are significantly increased, which can induce the expression of ACE2 and increase its activity to generate Ang 1-7, which can bring significant protective effects on the heart, brain, kidney, and blood vessels..However, other laboratory studies have shown that ACE inhibitor or ARB treatment may down-regulate ACE2 expression, but it has no significant effect on changes in its activity.4 ACE Inhibitor / ARB Treatment and Pneumonia 2012 The British Medical Journal (BMJ) published a systematic review and summary analysis that comprehensively evaluated ACE inhibitor or ARB treatment for pneumonia and pneumonia-related mortality.Searching in PubMed database, Web of Science database and FDA file database, 37 clinical studies that met pre-set inclusion criteria and no exclusion criteria were included in the systematic review and summary analysis, of which 18 were randomized controlled trials, 11Cohort studies, 2 nested case-control studies and 6 case-control studies.The results showed that patients treated with ACE inhibitors had a 34% lower risk of pneumonia (OR 0.66, 95% CI 0.55-0.80) compared to the control group, and Asian patients had a 57% reduction in pneumonia risk (OR 0.43, 95%).(CI 0.34-0.54), and a 27% reduction in the risk of pneumonia-related deaths in patients receiving concurrent ACE inhibitor treatment (OR 0.73, 95% CI 0.58-0.92); patients with stroke, or heart failure, or chronic kidney disease receiving ACE inhibitionThe risk of pneumonia was significantly reduced in patients treated with the drug; the risk of pneumonia was not significantly reduced in patients receiving ARB (OR 0.95, 95% CI 0.87-1.05), but the pneumonia-related mortality rate was significantly reduced (OR 0.63, 95% CI0.40-1.01).Patients receiving ACE inhibitors had a 31% lower risk of developing pneumonia than patients receiving ARB (OR 0.69, 95% CI 0.56-0.85), and the difference in pneumonia-related mortality was not significant (OR 1.20, 95% CI 0.72-2.00).A retrospective case analysis published in 2018 explored a slightly higher risk of pneumonia in 539 previously diagnosed patients with viral pneumonia (OR 1.34, 95% CI 0.74-2.44), but tracheal intubationHigher risk of mortality or mortality (OR 3.02; 95% CI 1.30–7.01), while those who continued to be treated with ACE inhibitors during hospitalization had a slightly lower risk of pneumonia (OR 0.64, 95% CI 0.34-1.19), and tracheal intubation ratesAnd / or mortality were significantly lower (OR 0.25; 95% CI 0.09–0.64).The risk of pneumonia was slightly higher in patients previously treated with ARB (OR 1.65, 95% CI 0.63-4.29), but the risk of tracheal intubation and / or mortality did not change significantly (OR 1.12; 95% CI 0.30–4.10), while hospitalizationPatients who continued to receive ARB during the period had a slightly lower risk of pneumonia (OR 0.48, 95% CI 0.17-1.37), and there was no significant change in the risk of tracheal intubation or mortality (OR 0.75; 95% CI 0.16–3.44).It can be seen that overall, after receiving ACE inhibitor or ARB treatment, the risk of various pneumonia and the risk of pneumonia-related deaths are reduced, especially in those receiving ACE inhibitor treatment.There are few clinical studies on ACE inhibitors or ARB treatment and viral pneumonia. Retrospective studies suggest that among patients diagnosed with pneumonia admitted to hospital, the risk of tracheal intubation and death is lower.There are no reports of clinical studies on the effects of ACE inhibitors or ARBs on lung injury in patients with SARS or SARS-CoV-2 infection.5 The clinical application of ACE inhibitors and ARBs during the SARS-CoV-2 infection epidemic suggest that the Spike glycoprotein of ACE2 may play an important role in the process of coronavirus entering host cells.In animal experiments, the decrease of ACE2 expression and its activity in lung tissue may be related to severe lung damage.However, in the human RAS system, ACE and ACE2 are the two key adjustments for mutual checks and balances.Published studies have shown that the effects of ACE inhibitors and ARBs on ACE2 are quite limited in clinical treatment.In humans, there is no consistent research on the relationship between RAS inhibitors and ACE / ACE2.Clinically, after receiving ACE inhibitors or ARBs, the overall risk of various pneumonias and the risk of pneumonia-related deaths are reduced.There are very few clinical studies on ACE inhibitors or ARB treatment and viral pneumonia. Retrospective studies have not shown that the rate of viral infection or the risk of pneumonia in patients who have long-term use of ACE inhibitors / ARB is significantly higher than those who do not use these two drugs.Therefore, in clinical practice, for patients who have been treated with ACE inhibitors / ARB (hypertension, coronary heart disease, heart failure, diabetes or kidney disease), the recommendations are as follows: Those who are not infected with SARS-CoV-2, continue to take the previous effectiveACE inhibitor / ARB; SARS-CoV-2 infection or mild pneumonia: ACE inhibitor / ARB should always be taken.If it can be tolerated, you can consider increasing the dose to a sufficient amount. Regardless of whether SARS-CoV-2 infection is confirmed, if there is a change in blood pressure or cardiovascular disease symptoms, you should immediately see a doctor or consult a cardiovascular disease specialist, and adjust the relevant treatment according to your doctor’s orderOr dose; Severe pneumonia caused by SARS-CoV-2: respiratory support, strengthening anti-infection, maintaining hemodynamic stability.The use of ACE inhibitors / ARBs depends on the patient;
Serve patients with evidence-based medicine.The results of pathophysiology or pharmacology experiments are far from the clinical disease process, so it is not advisable to use a hard case to directly guide clinical practice. In the special period of SARS-CoV-2 infection outbreak, everyone may have a moment of fear or tensionmood.Clinicians need to pay special attention to the patient’s mood and sleep status.If the patient is not sleeping well or has anxiety, consider adding additional sleep-improving or anxiolytic drugs, as appropriate.The above content is only authorized for exclusive use by 39Health.com, please do not reprint without the authorization of the copyright party.

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CARDIOLOGY

Are you clear about diuretic optimization for chronic heart failure?

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Congestion is at the heart of the pathophysiology of heart failure.Increased heart filling pressure, sometimes called hemodynamic congestion, can cause many of the major symptoms of heart failure, such as edema, sitting breathing, and exertional dyspnea.Therefore, the treatment of congestion is very important in the care of patients with heart failure.Although data from randomized controlled trials are still lacking, based on decades of clinical experience, diuretics have become standard care medications for the treatment of congestion in patients with heart failure and have been recommended by clinical guidelines.
“Diuretic optimization” is still unclear. The current guidelines highlight the importance of optimized guide-directed drug therapy (GDMT) for the treatment of chronic heart failure.However, recent studies have found important gaps in optimizing medications for heart failure, including baseline and titrated doses.These gaps have prompted more people to demand better strategies to promote the optimization of GDMT.So far, studies targeting natriuretic peptides to promote GDMT optimization have shown different results.Optimization efforts are usually appropriately focused on drugs that improve long-term efficacy, such as beta blockers, renin-angiotensin system (RAS) inhibitors, and mineralocorticoid receptor antagonists.Although diuretics have an important role in the treatment of heart failure, few people have devoted themselves to diuretic optimization.In fact, what “diuretic optimization” means is not yet clear.Observational data suggest that high-dose diuretics may be associated with worse outcomes.It is speculated that the “optimized dose” of diuretics may be the lowest dose to effectively manage the symptoms and signs of congestion and prevent hospitalization and disease progression.However, are there patients with heart failure who have the correct diuretic dose of 0?In addition, multiple medications are an important issue in the treatment of cardiovascular disease; de-prescribing of non-essential medications is also an undervalued but important part of long-term care.For clinicians who care for patients with heart failure (many patients take 6 or more drugs daily to treat heart failure), more patients will ask “whether they need to continue taking all the drugs”.Introduction to Diuretic Optimization Studies In this context, the research published by Rohde et al. In Eur Heart J provides key data directly related to daily clinical decisions.The study was a prospective, double-blind, randomized controlled trial and randomly selected 188 patients with chronic heart failure and ejection fraction ≤45% from 11 clinics in Brazil. Patients were treated with conventional nursing strategies or diuretic withdrawal strategies..In the study, patients should be selected with special care to ensure that they are a low-risk group and can tolerate diuretic withdrawal. ① Patients admitted to the hospital without heart failure or admitted to the emergency room for heart failure within the first 6 months②In the first 6 months, the patient took stable and low-dose diuretics (furazomib: 40-80 mg / d, orally) and optimized GDMT treatment; ③except evidence of clinical congestionPatients with a score> 5).The main outcomes of interest were patient symptoms (dyspnea score) and the proportion of patients who successfully discontinued 袢 diuretics during follow-up.Studies have shown no significant differences in dyspnea between patients who were randomly discontinued from the furazomib group and those who continued to receive the furazomib group.There was also no statistically significant difference in the end point of the main composite event for furosemide re-administration. The HR of the patients was 1.69, and the confidence interval was wide, indicating that the endpoint was not effective.In addition, the study’s follow-up time was relatively short (90 days), and the risk of clinical events such as hospitalization for heart failure between the two groups was similar and less.Research limitations Thankfully, researchers have designed and conducted a clinically relevant trial that is more difficult to perform (well known, strategic trials are challenging).The rigor of the methodology is particularly important for the design of double blindness in order to avoid patient or clinician bias.Fundamentally, this study is a safety trial designed to verify whether tritium diuretics can be safely stopped without adverse clinical outcomes in selected heart failure (HFrEF) with reduced ejection fraction.However, the study was far less effective in assessing the most relevant adverse event outcomes (hospitalization or death due to heart failure), with only 10 such events occurring throughout the study.For chronic heart failure trials, the 90-day follow-up period is shorter, and longer follow-up times may lead to more patients resuming diuretics.In addition, the selected patients are usually in the very low-risk subgroup of HFREF. The patients are usually younger, have a good background treatment for heart failure, have nearly normal renal function, and have a slight increase in natriuretic peptide levels.How can this data be applied to clinical practice?Based on the data provided, it is relatively safe for low-risk patients (such as those in this study) to discontinue discontinuation of diuretics with appropriate monitoring, at least for a short time.However, in routine clinical practice, which patients with heart failure are eligible for this protocol are uncertain.It is understood that patients with chronic heart failure who do not need to use diuretics to maintain clinical stability have a good prognosis.In high-risk patients, stopping heart failure treatment for a short period of time can lead to elevated natriuretic peptide levels and hemodynamic congestion.Therefore, patient selection is particularly important.In addition to proper patient selection, another key issue with this approach is adequate monitoring.Initial experience with spironolactone in patients with previous heart failure shows that safe and effective treatment can be performed under fully monitored clinical trial conditions, and safety may be reduced in routine clinical practice.Finally, this study did not include patients with heart failure (HFpEF) with ejection fraction retention, so these data cannot be extrapolated to HFpEF patients..
CONCLUSIONS Although the current research does not explicitly point out, in some cases, diuretic optimization may help achieve more effective GDMT.Early Sacubitril / Valsartan-related clinical trials have shown that reducing the diuretic dose by 50% at the start of treatment may help relieve hypotension, especially in patients with low baseline blood pressure.In contrast, patients with normal blood volume rather than overload are better tolerated by initial beta-blocker therapy.Therefore, formulating the best treatment for chronic heart failure requires a combination of science and medicine.Although the use of diuretics in heart failure is usually more artistic, the data from Rohde et al. Add important evidence for the rational use of diuretics.The above content is only authorized for exclusive use by 39Health.com, please do not reprint without the authorization of the copyright party.

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CARDIOLOGY

To reduce the recurrence of atrial fibrillation, these eight “prescriptions” for life, do you know?

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To reduce the recurrence of atrial fibrillation, Dr. Anthony Pearson, from St. Luke’s Hospital in St. Louis, spent a long time discussing with his patients with AF what lifestyle options are available.However, in the process, he found that more patients did not know what could be done to reduce the recurrence of AF.Therefore, it proposed 8 important lifestyle “prescriptions” to reduce the incidence and recurrence of AF.
Avoid or drastically reduce alcohol intake.? It is recommended that obese people lose weight.Smoking cessation: reduces the risk of AF by 36%.? Effective blood pressure control.? Regular aerobic exercise.Medium intensity aerobic exercise for at least 150 minutes per week.• Eat healthy and do n’t eat junk food.Generally speaking, regardless of your diet plan, maintaining a body mass index (BMI) of <28 kg / m ^ 2 is fine.Healthy diets that help control your weight include fresh vegetables, nuts, olive oil, and fish. Avoid ultra-processed foods, sugary drinks, and reduce the intake of polished rice, pasta, pastries, and potatoes.Eat moderate amounts of full-fat yogurt and cheese.• Get quality sleep.This means that in addition to getting good sleep, sleep apnea-like diseases should be treated.The risk of atrial fibrillation in patients with obstructive sleep apnea (OSA) is four times that of the general population and independent of other confounding factors.?Reduce the pressure.Patients can try meditation, yoga, reduced working hours, psychotherapy, etc.Use personal ECG monitoring equipment (especially under the supervision of a doctor) to understand the onset of AF or help reduce stress.So, what effects does alcohol, exercise, and obesity have on the onset of AF?Some research evidence published some time ago may provide some reference for us.Effects of Alcohol on Atrial Fibrillation In March 2019, a trial of alcohol and AF by Dr. Pearson in NEJM showed that heavy drinking can induce AF.Observational studies have shown that the greater the amount of alcohol consumed, the higher the incidence of AF.The trial published by Dr. Pearson is the first relevant randomized controlled trial.Patients with moderate alcohol use who had paroxysmal atrial fibrillation (at least 2 episodes in the past 6 months) or persistent AF were included in the study.Patients were randomly divided into an abstinence group and a control group. Comprehensive heart rate monitoring was performed using an implantable cycle recorder (ILR) or an existing pacemaker. AliveCor monitoring was performed twice daily for 6 months.The abstinence-free survival of subjects in the abstinence group was prolonged by 37% (118 vs. 86 days), and the burden of AF was reduced from 8.2% to 5.6%.Atrial fibrillation-related admissions occurred in 9% and 20% of patients in the abstinence group and control group, respectively.In addition, the abstinence group improved symptoms and blood pressure, and lost weight.This trial showed patients with atrial fibrillation with precise numbers that reducing alcohol consumption is essential if you want to reduce AF episodes.The study further emphasized that lifestyle changes can significantly reduce the incidence of AF.The effect of obesity on atrial fibrillation There is a close relationship between obesity and atrial fibrillation.Data show that we can make atrial fibrillation by fattening sheep and fat infiltrating the left atrium.Recently, there is conclusive evidence (LEGACY trial) that weight loss can significantly reduce AF recurrence.The Australian LEGACY trial included 355 patients with atrial fibrillation with a BMI> 27 kg / m ^ 2 and developed a weight management plan for them. The patients were followed up once a year.The study endpoints included effects on the severity of AF and 7-day Holter ECG monitoring results.Studies have shown that patients with a weight loss of ≥10% are 6 times more likely to have no AF recurrence than those with less weight loss.When the weight fluctuates too much, the probability of AF recurrence can double.Of course, all factors are interrelated.Exercise, diet, stress, drinking, and sleep quality all affect weight control and obesity.Atrial fibrillation patients should do the above eight to get the best benefit.According to the LEGACY trial, patients with atrial fibrillation and obesity should use all lifestyle factors to slowly and steadily lose 10% of their weight.These lifestyle changes can benefit a lifetime.Effects of exercise on AF. Convincing evidence that AF can reduce AF comes from a Norwegian study of 51 patients with AF.In the study, patients were randomized to perform intermittent aerobic exercise (AIT) or maintain their regular exercise habits.Patients in the AIT group performed 4 times of high-intensity aerobic exercise (heart rate reached 85% -95% of peak heart rate) for 4 minutes, and 3 minutes of active recovery was performed between the two aerobic exercises.
Studies have shown that patients with AIT detected by ILR have significantly reduced atrial fibrillation load, and the average time of atrial fibrillation decreased from 8.1% to 4.8%, with no significant change in the control group.Patients in the AIT group experienced fewer and fewer severe symptoms, while the non-exercised control group did not change.In addition, compared with the control group, the peak oxygen consumption, cardiac function, quality of life, BMI, and blood lipid levels of patients in the AIT group were improved.AIT in Norway: Endurance training by walking or treadmill, 3 times a week for 12 weeks.Before each training, warm up for 10 minutes (60% -70% of the peak heart rate), then perform 4 4 minutes of exercise (85% -95% of the peak heart rate), and 3 minutes of active recovery during the interval (the peak heart rate of60% -70%), and finally ended with 5 minutes cooling period exercise.During AF, patients can exercise at the same treadmill speed and inclination during sinus rhythm, with a Borg score of 6-20 to control exercise intensity.After being familiar with the exercise program, the patient can do it at home once a week, and the exercise intensity should be recorded by a heart rate monitor.The above content is only authorized for exclusive use by 39Health.com, please do not reprint without the authorization of the copyright party.

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CARDIOLOGY

Susceptible people?

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The new coronavirus pneumonia epidemic is raging, and patients with chronic diseases are faced with a “drug withdrawal” problem. For patients with hypertension, stopping the drug means blood pressure rebound, and even cardiovascular accidents may occur.Want to go out and buy medicine, but I heard that high blood pressure is a susceptible group of new coronavirus, many people are in a dilemma.How can people with hypertension tackle these obstacles during the epidemic?Are people with hypertension more likely to be infected with the new coronavirus?According to the existing clinical data, in confirmed and death cases, hypertension patients do account for a significant proportion.Some people have questions, does this mean that people with hypertension are susceptible?According to the data of a recent article published in The Lancet, among all patients with new-type coronavirus pneumonia, the proportion of patients with hypertension is 15%, which is even lower than the prevalence of hypertension in China.People with blood pressure are more susceptible.In addition, considering the overall prevalence of hypertension in China, hypertension is the chronic disease with the highest prevalence, at about 27%.With such a large base, the proportion of patients with new-type coronavirus pneumonia infected with hypertension will be correspondingly higher.In addition, most people with chronic diseases are older, have multiple complications, and have relatively low resistance, so they are more likely to be infected with the new coronavirus pneumonia.What should people with hypertension pay attention to when they are isolated at home?During home isolation, vegetable meat, like antihypertensive drugs, faced a situation of “supply in short supply”.Many families choose to replace instant fresh vegetables with convenient fast foods, and most of these foods contain high sodium salts. Long-term consumption can easily cause blood pressure to rise.Moreover, because you can’t go out, the amount of exercise in patients with hypertension is greatly reduced, which is also an important cause of increased blood pressure.The World Health Organization recommends an adult sodium intake standard of 5g / d, while the Chinese average daily intake is 10.5g.For patients with hypertension, daily salt intake should be controlled, and the daily diet should be light.In addition, exercise can not be dropped, you can do some simple exercises at home, such as walking around the circle, Tai Chi, etc.Emotions also have a certain effect on blood pressure. During the epidemic, pay attention to adjust your mentality, do not have too much emotional fluctuations, regular self-blood pressure monitoring will help stabilize blood pressure.Special attention should be paid not to stop medicines and reduce medicines because of the inconvenience of going out to buy medicines. At present, relevant policies have slowed down the one-time medication requirements for patients with chronic diseases, and they can communicate with doctors to solve medication problems.

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CARDIOLOGY

New coronavirus pneumonia or myocardial injury, how to deal with fulminant myocarditis?

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In addition, a number of medical experts mentioned that some patients with new-type coronavirus pneumonia have increased markers of myocardial injury and have symptoms similar to myocarditis.Recently, Academician Ge Junbo, a well-known cardiovascular expert, also wrote in a letter to all students that some patients may have the pathological process of fulminant myocarditis (FM) or “heartbreak syndrome”.According to a report from the Wuhan Municipal Health and Health Committee, Xiong Mou (male, 69 years old) with new type of coronavirus pneumonia had severe myocarditis (myocardial enzymes reached 20 times normal, abnormal electrocardiogram), abnormal renal function,Impaired organ function.Data show that FM is the most severe type of myocarditis and is usually caused by a viral infection.The onset is rapid and the disease progresses rapidly. Patients can quickly develop hemodynamic abnormalities (such as pump failure and circulatory failure) and severe arrhythmia, often accompanied by respiratory failure and liver and kidney failure, with extremely high early mortality.So, what about patients with suspected FM?Recently, the AHA’s Scientific Statement on the Diagnosis and Treatment of Fulminant Myocarditis may provide some reference for us.AHA Scientific Statement: Management of Suspected FM 1. Symptoms and Signs of FM and Early Assessment FM symptoms and signs may vary due to inflammation or infection, including cardiogenic shock, dyspnea, arrhythmia and chest pain, and even sudden death.Early suspected and hemodynamically stable patients can undergo auxiliary examinations such as electrocardiograms and chest X-rays.Patients should have a pH for venous blood gas analysis, lactic acid (which can be performed quickly and quickly obtain the patient’s perfusion and ventilation status), a complete blood cell count, basic metabolic indicators, and total bilirubin, alanine aminotransferase, and aspartateTests such as acid transaminase to determine early symptoms of right heart failure.In addition, patients should be tested for biomarkers (including at least cTn, and BNP or NT-proBNP) to determine whether the patient has evidence of increased myocardial wall stress and myocardial necrosis.2. Mechanically assisted supportive therapy for cardiogenic shock is usually the initial manifestation of FM patients.In other reviews and scientific statements, including the recent Circulation’s AHA Scientific Statement: Contemporary Management of Cardiogenic Shock, the review of FM identification and management with vasoactive drugs and mechanically assisted supportive care is reviewed.In addition, cardiogenic shock in FM is often accompanied by arrhythmias, including atrial and ventricular tachyarrhythmias, bradycardia caused by bradycardia, bradycardia, and sudden cardiac death.European epidemiological and therapeutic studies of inflammatory heart disease show that 18% of patients with suspected myocarditis have arrhythmias (mostly tachyarrhythmias).Because exercise can induce arrhythmias, the current AHA and ESC statements do not recommend that patients with acute myocarditis participate in competitive sports with continued inflammation.In unstable situations, patients may develop FM.For patients with cardiac arrest and pulseless arrhythmias, initial treatment should be performed in accordance with the current AHA Advanced Life Support Guidelines, focusing on circulation, airway and breathing to provide life support to patients.In addition, high-quality chest compressions are the focus of recent guidelines.In the emergency room, patient management should explore recovery and stability.For incapable hospitals, it is necessary to consider referring patients to tertiary hospitals.When the patient is critically ill, it is too late to refer for treatment again, so early referral is the best choice for patients with cardiogenic shock.In addition, initial stabilization requires hemodynamic support and, if necessary, respiratory support to maintain tissue perfusion and oxygen supply to end organs.Emergency department staff should first understand hospital resources. If patients have early signs of circulatory failure but the hospital cannot provide advanced circulation support, they should consider transferring the patient to a tertiary hospital with advanced circulation support.In patients with a shock multidisciplinary response group, the group should be activated before multisystem organ failure begins or worsens to develop the most appropriate support program and implement it quickly.If feasible, the ECLS team can assess the potential for ECLS intubation and the recovery of unstable patients who cannot metastasize.If necessary, ECLS is the fastest way to support circulation, oxygenation / ventilation in unstable patients.Almost all patients with FM need to use vasoactive drugs or temporary mechanically assisted circulation (MCS) to help patients reach a certain stage.At this stage the patient’s own circulation or other more durable solutions can maintain the function of the end organs.Many centers have experience with bedside percutaneous ECLS intubation and immediate supportive care.Many centers are also adept at using percutaneous double ventricular assist devices without the need for extracorporeal oxygenation, thereby eliminating some of the risks associated with ECLS and the inherent need for oxygenators.In addition, these percutaneous assist devices can provide dual ventricular unloading, thereby reducing ventricular wall stress and reducing the possibility of further exacerbating inflammatory heart injury.In FM patients, there are few randomized controlled trials evaluating the efficacy of temporary MCS devices.Several cases have shown that once the patient’s circulation and end organ perfusion are adequately supported, time can be gained for cardiac recovery.In patients with fulminant lymphocytic myocarditis, the heart usually recovers over time, and in other immune-mediated FM subtypes, the heart can be recovered by appropriate immunomodulatory therapies.In patients who are not recovering or waiting for a heart transplant, the use of temporary MCS devices can provide support in the short term to maintain patient stability.In addition, regardless of the patient’s pathogenesis, once stable, all patients with FM and systolic dysfunction can benefit from neurohormone antagonist treatment.Neurohormone antagonists and diuretics are the basis for treating heart failure.How is the Chinese consensus recommended for the treatment of FM?”2017 Chinese Expert Consensus on Diagnosis and Treatment of Fulminant Myocarditis in Adults” recommends “a comprehensive life-saving treatment plan for adult fulminant myocarditis”.1. Close monitoring All patients with FM should be closely monitored.Admit patients to or transfer to the cardiac intensive care unit as soon as possible, closely monitor ECG, blood oxygen saturation, and blood pressure, and monitor laboratory indicators such as blood routine, myocardial enzymes, liver and kidney function, electrolytes, coagulation function, and blood gas.2. Active general symptomatic and supportive treatment All patients with FM should undergo symptomatic and supportive treatment, including: ① absolute bed rest; ② a light, digestible, nutritious diet, eat less and eat more; ③ give oxygen; ④ improveMyocardial energy metabolism (Phosphokinase, Coenzyme Q10, etc. can be given), Trimetazidine application can help improve heart function; ⑤ Supplement water-soluble and fat-soluble vitamins; ⑥ Liquid supplement.3. Antiviral therapy Viral FM patients should be treated as early as possible, such as oseltamivir, paramivir, acyclovir, ganciclovir and other drugs.In addition, interferon can be tried for treatment, especially those with enterovirus infection.4. Immunomodulatory therapy All FM patients should be given glucocorticoid and gamma globulin as soon as possible for immunomodulatory therapy.(1) Glucocorticoids Glucocorticoids have the effects of inhibiting immune response, anti-inflammatory, anti-shock, and anti-multi-organ damage, can eliminate allergic reactions, inhibit inflammatory edema, and reduce the adverse effects of toxins and inflammatory factors on the myocardium.Recommended for severe patients, early and sufficient.After intravenous injection of 10-20 mg of dexamethasone, intravenous drip of methylprednisolone can be used to make it work as soon as possible.(2) Immunoglobulin (IVIG) Immunoglobulin has dual functions of anti-virus and anti-inflammatory. On the one hand, it helps the body to eliminate viruses by providing passive immunity, and on the other hand, it reduces the cells by regulating the function of antigen-presenting cells and T helper cells.Factor production, thereby reducing myocardial cell damage, improving left ventricular function, reducing the occurrence and death of malignant arrhythmias.5. Life support therapy (1) Circulating treatment of IABP: It is recommended that FM patients with hemodynamic instability be treated with IABP as soon as possible.Extracorporeal membrane oxygenation (ECMO): For patients with hemodynamically unstable FM, ECMO should be recommended for early treatment.When IABP is still not correct or sufficient to improve circulation, ECMO therapy should be enabled immediately or directly.ECMO is often used in combination with IABP to give the heart a fuller rest and earn time for its functional recovery.(2) Respiratory support Ventilator-assisted ventilation can improve lung function, reduce patient workload and cardiac work, and is one of the important treatments for FM combined with left heart failure.There are two types of respiratory support: ① Non-invasive ventilator assisted ventilation: It is recommended that patients with dyspnea or breathing frequency> 20 breaths / min can be used with patients with ventilator ventilation.Those with poor results or unable to adapt should be changed to tracheal intubation.② Airway intubation and artificial mechanical ventilation: respiratory failure, especially patients with significant respiratory and metabolic acidosis and affecting consciousness must be used.It should be used actively for patients with shortness of breath and blood oxygen saturation that cannot be maintained under non-invasive assisted ventilation; patients with shortness of breath or labor should also be actively used.(3) Blood purification and continuous renal replacement therapy (CRRT) FM patients, especially those with acute left ventricular dysfunction, should be considered as soon as possible. Cyclic failure and shock are not contraindications for this treatment.On the contrary, it indicates that the condition is serious, and it needs to be used as soon as possible.Small sample clinical research results show that immunoadsorption therapy (IA) can improve the patient’s cardiac function, clinical manifestations, hemodynamic parameters, improve exercise endurance, and reduce NT-proBNP levels.In addition, IA can reduce myocardial inflammatory response, and after applying protein A immunoadsorption treatment, left ventricular systolic function is improved.Recommended if possible.6. Medical treatment of shock and acute left heart failure (1) Medical treatment of shock is first given dopamine and 5% sodium bicarbonate, and if necessary, a small dose of m-hydroxylamine is added to temporarily maintain basic vital signs.As part of anti-shock therapy, glucocorticoids should be used early and in sufficient quantities.(2) Drug treatment for acute left heart failure includes positive pressure breathing, ultrafiltration of blood, and diuretics. When the heart rate increases significantly, digitalis is used in small amounts.Because patients have low blood pressure, vasodilators should be used with caution.7. Arrhythmia treatment is based on the type of arrhythmia and combined with the patient’s hemodynamic status.The general treatment principles are: ① Quickly identify and correct hemodynamic disorders.② Those with relatively stable hemodynamics should choose appropriate treatment strategies and antiarrhythmic drugs according to clinical symptoms, cardiac function status, and arrhythmia properties; preventive measures should be taken after the arrhythmia is corrected to try to reduce recurrence.③ Actively improve cardiac function and hypotension, and correct and deal with internal environment disorders such as electrolyte disorders, blood gas and acid-base balance disorders.④ It is not suitable to use β-blockers, non-dihydropyridine calcium antagonists and other anti-arrhythmic drugs with negative muscle strength and negative frequency; intravenous pumping of amiodarone is preferred, but rapid intravenous bolus should not be used; fast ventriclePatients with atrial fibrillation can be administered digitalis to control ventricular rate.⑤ Those with bradycardia should first consider implanting a temporary pacemaker. When there is no condition, they can temporarily use drugs that increase heart rate, such as isoproterenol or atropine.⑥ Most patients with FM can be cured after the acute phase.In patients with bradycardia, permanent pacemaker implantation is not recommended in the acute phase.Need to observe more than 2 weeks, the conduction block has not recovered after the systemic condition is stable, and then consider whether to implant a permanent pacemaker.The above content is only authorized for exclusive use by 39Health.com, please do not reprint without the authorization of the copyright party..

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CARDIOLOGY

How to treat hypertension, these indicators need to be clear

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Many young people end up with high blood pressure and suffer from diseases such as high blood pressure because of poor daily habits. At this time, they must receive antihypertensive treatment. At present, clinically low blood pressure mainly depends on some drugs, so highWhat is the basis of blood pressure treatment?The following professionals are invited to explain these common sense to everyone.What is the basis for treating hypertension?The basis for the treatment of hypertension: (1) There must be two prerequisites: ① Have a clear understanding of the causes, pathogenesis, pathology, target organ damage, comorbidities and some risk factors of hypertension.② At present, there are a number of antihypertensive drugs with different action mechanisms and high safety in the clinic for you to choose. Eating antihypertensive drugs early can prevent target organ damage.(2) The target of antihypertensive pressure in different patients with hypertension is different. The general target of antihypertensive must be sbp.(3) In the hospital, the doctor will formulate a personalized treatment plan according to the actual situation of each hypertension. Different treatment principles are adopted for patients with different levels of hypertension, as follows: Low-risk patients: change their living habits asMainly, if there is no effect after 6 months, then combine with medication; intermediate-risk patients: First of all, you should actively improve your lifestyle and observe the patient’s blood pressure and whether there are other risk factors to further understand the actual situation of the patient, thenDecide if you need medical treatment.High-risk patients: must be treated with antihypertensive drugs immediately.Very high-risk patients: Intensive treatment of hypertension and some existing complications must be started immediately, and can no longer be delayed.Regardless of the severity of the hypertension patients, some bad habits should be changed first. If everyone’s bad habits are not changed, blood pressure is difficult to control.Some patients who are not too wet may not even take antihypertensive drugs after their lifestyle changes.What is the basis for treating hypertension?The basis for the treatment of hypertension has been explained very clearly to everyone. I hope that all patients with hypertension can receive antihypertensive treatment in the first time. The earlier the treatment time, the faster the blood pressure will return to normal, which can reduceHarm to the body.

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