tailieunhanh - Perioperative Critical Care Cardiology - part 4

Trong nghiên cứu thứ hai [15], khối lượng cả hai tâm nhĩ trái và mức độ rối loạn chức năng tâm trương có giá trị tiên đoán độc lập. Một cơ chế quan trọng góp phần phát triển AF ở bệnh nhân tiểu đường bị suy tim | 80 A. Perkan diography abnormal relaxation hazard ratio pseudonormal relaxation hazard ratio and restrictive left ventricle diastolic filling hazard ratio 15 . In the latter study 15 both left atrial volume and the extent of diastolic dysfunction had independent predictive value. Another important mechanism that contributes to AF development in diabetic patients with chronic heart failure is neurohumoral modulation with elevated concentrations of catecholamine and angiotensin II. Collectively elevated catecholamines and angiotensin II may promote and produce changes in atrial fibrosis 16 17 atrial conduction and refractoriness conducive to AF. Management of Diabetic Patients with Heart Failure and Atrial Fibrillation Diabetes mellitus is a diagnosis of considerable and ominous importance in cardiovascular medicine related to significantly higher mortality and morbidity and causing numerous hospital readmissions. Early activation of the sympathetic nervous system induces a decrease of myocardial function and activation of the renin-angiotensin system results in unfavorable cardiac remodeling. The presence of AF in diabetic patients with heart failure may have an additional deleterious effect. The hemodynamic consequences of AF include inappropriate ventricular rate loss of atrial contraction and elevated filling pressures causing atrial dilatation and reductions in stroke volume. AF is also associated with increased risk of stroke. Pharmacological interventions including meticulous metabolic control of the diabetes decrease mortality and delay the progression of cardiovascular disease in diabetic patients. Beta-Blockers p-blockers are effective in improving outcome in diabetic subjects 2 12 18 reducing mortality by 30-40 after myocardial infarction and by 25-30 in congestive heart failure. p-blockers are an important component of pharmacological treatment in diabetic patients for rate control in those with AF. Several mechanisms are

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