Kürşad TURGUT, Havva SÜLEYMANOĞLU, Merve ERTAN, Mehmet Ege İNCE

Köpeklerde Geriatrik Kardiyoloji - Bölüm 1: Geriatriklerde Kalp Yetmezliğinin Klasifikasyonu ve Tedavisi

Bu derlemede yaşlanmanın kalp üzerine etkileri, geriatrik köpeklerde kalp yetmezliğinin (HF) klasifikasyonu ve terapötik yaklaşımları konularında güncel bilgiler vermek amaçlanmıştır. Yaşlanma progressif HF'ne yol açan fizyolojik ve biyolojik değişikliklere yol açar. Hemen hemen tüm kardiyovasküler hastalıklar (CVDs) HF'ne yol açabilir. Geriatrik köpeklerde, HF başlıca; diyastolik kalp yetmezliği, HF ile korunmuş ejeksiyon fraksiyonu (HF/PEF) olarak, sistolik kalp yetmezliği, HF ile düşük ejeksiyon fraksiyonu (HF/düşük-EF) olarak klasifiye edilir. Tüm HF hastalarının ortalama %50'sini HF/PEF oluşturur ve geriatriklerde prevalansı daha yüksektir. Geriatrik insanlarda HF/düşük EF için tedavi başlıca ACE inhibitorleri veya ARBs, ?-blokörler, aldosterone antagonistleri ve ACE inhibitorleri veya nitrat intöleransı olan hastalara hydralazine-nitrat kombinasyonunu kapsar. Semptomların kontrolu ve morbidite faydası için diüretikler ve digoxin kullanılır. Kalp yetmezliği olan köpeklerde ACVIM panelislerince tavsiye edilen tedaviyi furosemide, ACE-I, ve pimobendan oluşturmaktadır. HF/PEF olan hastalardaki klinik çalışma verileri mortalite faydası olmadığını göstermiştir. Tedavi semptomların iyileştirilmesi ve primer nedenin tedavisine yönelik yapılır.

Geriatric Cardiology in Dogs - Part 1: Classification and Treatment of Heart Failure in Geriatrics

The purpose of this article is to give current information on the effect of aging on heart, clasification of heart failure (HF) in geriatric dogs and therapeutic advances and challenges. The aging process results in a host of physiological and biological changes that lead to progressive HF. Nearly any cardiovascular disease (CVD) can lead to HF. HF in geriatric dogs is broadly classified into: Diastolic heart failure is defined as HF with preserved ejection fraction (HF/PEF), systolic heart failure is also known as HF with low ejection fraction (HF/low-EF). Importantly, HF/PEF accounts for approximately 50% of all HF patients and its prevalence is higher in the elderly. In humans, mortality and morbidity benefits for HF/low-EF have been reported with angiotensin-converting enzyme inhibitors (ACE-Is) or angiotensin receptor blockers (ARBs), ?-blockers and aldosterone antagonists, and the hydralazine-nitrate combination in patients intolerant to ACE inhibitors or nitrates. Therapies for symptom control and morbidity benefit include diuretics and digoxin. The most common and suggested therapy for dogs with HF by ACVIM panelists is furosemide, ACE-I and pimobendan. Pharmacological therapy is limited for HF/PEF as the results of small trials have been inconclusive. To date, clinical trials in HF/PEF patients have not shown mortality benefit so that management is focused on symptom relief and treatment of the underlying cause.

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