mercredi intensif_icc
TRANSCRIPT
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MERCREDI INTENSIFAbordagem da Insuficiência Cardíaca
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ASPECTOS INICIAIS
Definição - Classificação Sistólica vs. Diastólica
Epidemiologia Impacto da idade Evolução do tratamento (causa base inclusive)
Propedêutica
Exame complementares
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PROPEDÊUTICA E EXAMES COMPLEMENTARES
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ASPECTOS DE INTERESSE
Etiologia
Fator descompensador
Tratamento
Prognóstico
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ETIOLOGIA
Doença Coronariana; Hipertensão; Diabetes Mellitus. Influências geográficas na etiologia. Em até 20-30% diagnóstico etiológico
indeterminado.
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IC - ETIOLOGIA
ETIOLOGIAS DA INSUFICIÊNCIA CARDÍACA
Fração de Ejeção < 40% Fração de Ejeção preservada (> 40-50%)
Doença arterial coronariana* Idade
Sobrecarga crônica de pressão* Hipertrofia patológica
Sobrecarga crônica de volume Cardiopatias restritivas
Desordens genéticas – familiares Fibrose
Doenças infiltrativas* Doenças endomiocárdicas
Lesão por drogas – tóxicas
Doenças metabólicas*
Infeciosas Doenças Pulmonares
Desordens do ritmo Estados de alto débito cardíaco
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FATORES DE DESCOMPENSAÇÃO
Não adesão Tratamento inadequado Transgressão da dieta (incluindo restrição hídrica) Isquemia miocárdica Arritmias Anemia Início de alguma medicação ou droga que piorem a IC (p.ex:
AINE, BCC, BB, AA classe I e sotalol, AcAnti-TNF, álcool, etc...) Infecções Gravidez HAS Doença valvar aguda Alterações endócrino - metabólicas
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FISIOPATOLOGIA
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FISIOPATOLOGIA
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FISIOPATOLOGIA
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FISIOPATOLOGIA
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CLASSIFICAÇÃO DA NYHA – CAPACIDADE FUNCIONAL
Classe I
Classe II
Classe III
Classe IV
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EVOLUÇÃO EM ESTÁGIOS
Estágio A
Estágio B
Estágio C
Estágio D
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ESTÁGIOS E CLASSIFICAÇÃO FUNCIONAL
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TRATAMENTO
Doença Estável vs. Instável (aguda ou agudizada)
Medidas não farmacológicas
Medidas farmacológicas
Dispositivos eletro-mecânicos
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FISIOLOGIA APLICADA AO TRATAMENTO
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TRATAMENTO FARMACOLÓGICO
Drogas que interferem com a ativação excessiva do SRAA Quais? Em quem? Quando? Dose? Benefícios? Efeitos colaterais?
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TRATAMENTO FARMACOLÓGICO
Antagonistas da Aldosterona
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TRATAMENTO FARMACOLÓGICO Drogas que interferem com a ativação
excessiva adrenérgica
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TRATAMENTO FARMACOLÓGICO
Hidralazina + Nitrato
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TRATAMENTO FARMACOLÓGICO
Diurético
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TRATAMENTO FARMACOLÓGICO
Digital
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TRATAMENTO SEQUENCIAL
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TRATAMENTO SEQUENCIAL
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IC AGUDA OU DESCOMPENSADA
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TRATAMENTO FARMACOLÓGICOIC AGUDA OU DESCOMPENSADA
Diurético de alça
Dobutamina
Dopamina
Milrinona
Nitroprussiato de Na+
Nitroglicerina
Nesiritide
Levosimendan
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TRATAMENTO POR “DEVICES”
Ressincronização cardíaca
Desfibrilador Implantável
Na IC aguda - BIA
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TRATAMENTO - ALGORITMO
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TRATAMENTO - ALGORITMO
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BIOMARCADORES NA IC
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PROGNÓSTICO
Avaliação global: 30-40% morrem em 1 ano após
diagnóstico 60-70% em 5 anos
Causa: evolução da IC ou arritmias malígnas
Classe funcional (NYHA): IV – taxa de mortalidade anual de 30-70% II – taxa de mortalidade anual 5-10%
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