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PostSubject: importance of caution   Fri Apr 06, 2007 3:05 pm

It should be noted that the recommendation for use in patients with SCOP heavy суправентрикулярными and желудочковыми аритмиями соталол combines selective properties β-блокаторов and complications of Class III (кордароноподобный effect). The slow blocking calcium channels in the Majnoon based on the decline in the free calcium in cardiomiotitah and levelling asinhronii reduction, the improvement of myocardial relaxation and reducing its sokratimosti, suppression of thyroid diseases. Among blocking calcium channel drug of choice by most negative symptoms inotroponogo actions and the best profile pharmacological properties is verapamil. It provides symptomatic effect in 65-80% of patients, including рефрактерности to treatment β-блокаторами because of the ability to reduce drug ишемию attack, including безболевую and improve its диастолическое relaxation and податливость LV. This property verapamila improves patient tolerance to physical activity and the reduction subaortalni pressure gradient at rest less than β-blokatorami ability to reduce vnutrijeludockova obstruction in the physical and emotional stress and provocation izoproterenolom. At the same time, verapamil reduces force on vascular resistance because vazodilatatonego action. Although this effect, in most cases, get a direct positive impact on diastolicescuu LV function, the selected patients with basal vnutrijeludockova obstruction, coupled with the high konechno-diastolicesc m LV pressure and the tendency to systemic arterial hypotension at the same time reducing the постнагрузки внутрижелудочковый gradient pressure may rise sharply. This can cause inflammation of the lungs, кардиогенного shock and even sudden death. Such threatening complications drug верапамилом also described in patients необструктивной SCOP high pressure in the left предсердии, which it is attributable to the adverse effect инотропным preparation. This is the importance of caution in the early verapamilom treatment of this category of patients. Appointment of preparation should start in hospital with a low-dose (40 mg three times a day), with a gradual increases with good endurance to reduce variation alone to 50-60 in 1 min. The clinical effect is generally to the reception of at least 160-240 mg drug per day, and more convenient in the long prolongirovanne application forms. In view of the beneficial impact on верапамила диастолическую function and value субаортального pressure gradient in LV, as well as the proven ability to increase the survival rate of patients SCOP compared with the placebo appropriate preventive his appointment in asymptomatic patients SCOP high risk. Place diltiazema treatment SCOP definitively determined.

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