A new approach to treatment of heart failure: beta-adrenergic blockers

Abstract

<p>In multiple clinical trials, beta-adrenergic blockers have been shown to significantly decrease morbidity and mortality in adults with chronic congestive heart failure. Heart failure increases activation of the sympathetic nervous system and other neurohumoral systems. In the short term, activation of the sympathetic nervous system is a compensatory protective mechanism. These compensatory mechanisms have been shown to cause myocardial damage with chronic activation, which has been hypothesized to be a major contributing factor to the clinical deterioration of adults with heart failure. Studies have shown inhibition of sympatetic nervous system activity and concominant benefits with beta-adrenergic blockers. Consequently, beta-adrenergic blockers have evolved to become an important part of medical therapy for chronic congestive heart failure in adults. Pediatric heart failure is usually due to congenital heart disease than cardiomyopathy. Therefore, surgical correction is most important part of pediatric heart failure therapy. Additionally, children (especially infants) have important differences from adults in physiology and developmental changes. There is limited reported experience regarding the use of beta-adrenergic blockers in pediatric patients with heart failure. Nevertheless, these reports show improvement in symptoms and ventricular systolic function in children with heart failure. Prospective, randomized trials are necessary to answer the questions about beta-blocker therapy in pediatric heart failure.</p>

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<p>Kalp yetersizli?i tedavisinde yeni bir yakla??m: beta-adrenerjik blokerler</p>

<p>?ok say?da klinik ?al??mada, beta adrenerjik blokerlerin eri?kinlerde konjestif kalp yetersizli?i tedavisinde hastal?k ve ?l?m oran?n? ?nemli derecede azaltt??? g?sterilmi?tir. Kalp yetersizli?i sempatik sinir sisteminin ve di?er n?roh?moral sistemlerin etkinli?ini art?r?r. K?sa d?nemde, sempatik sinir sisteminin etkinli?inin artmas? koruyucu etki g?sterir. Uzun d?nemde bu koruyucu mekanizmalar?n miyokarda zararl? etki yapt??? ve eri?kinlerde kalp yetersizli?inde klinik tablonun bozulmas?na ?nemli katk?da bulundu?u ileri s?r?lmektedir. ?al??malarda beta adrenerjik blokerlerin sempatik sinir sisteminin etkilerini ortadan kald?rd??? ve yararl? etkileri g?sterilmi?tir. Sonu? olarak beta-adrenerjik blokerler eri?kinlerde s?re?en konjestif kalp yetersizli?i tedavisinin ?nemli bir k?sm?n? olu?turmaktad?r. ?ocuklarda kalp yetersizli?i kardiyomiyopatiden ?ok do?u?tan kalp hastal?klar?na ba?l?d?r. Bundan dolay?, cerrahi d?zeltme ?ocuklardaki kalp yetersizli?inin tedavisinin en ?nemli k?sm?n? olu?turur. k olarak, ?ocuklar (?zellikle s?t ?ocuklar?) fizyoloji ve geli?imsel de?i?iklikler a??s?ndan eri?kinlerden ?nemli farkl?l?klar g?sterir. ?ocuklarda kalp yetersizli?inde beta-adrenerjik blokerlerin kullan?m? ile ilgili s?n?rl? say?da ?al??ma vard?r. Bununla birlikte, bu ?al??malarda kalp yetersizli?i olan ?ocuklarda belirtilerin ve ventrik?l sistolik fonksiyonlar?n?n d?zeldi?i g?sterilmi?tir. ?ocuklarda kalp yetersizli?i tedavisinde beta-adrenerjik blokerlerin kullan?m? ile ilgili sorular? yan?tlamak i?in prospektif ve randomize ?al??malara gereksinim vard?r.</p>