Лекарственно-индуцированная сердечная недостаточность (часть 1: актуальность, распространенность, причины)

Сердечная недостаточность, несмотря на все достижения современной медицины, остается одним из наиболее распространенных, тяжело текущих и прогностически неблагоприятных состояний, требующих пристального внимания медицинской общественности. Разнообразие клинической картины в совокупности с большим количеством заболеваний, сопутствующих сердечной недостаточности, сочетается с достаточно сложной схемой фармакотерапии, в абсолютном большинстве случаев включающей несколько препаратов. Некоторые классы лекарственных средств способны провоцировать возникновение/прогрессирование сердечной недостаточности у лиц с дисфункцией левого желудочка, а также способствовать ее развитию у пациентов без сопутствующих заболеваний сердечно-сосудистой системы. Цель работы: анализ и систематизация данных о факторах риска развития лекарственно-индуцированной сердечной недостаточности и ее распространенности при применении различных групп лекарственных средств. Установлено, что наиболее часто лекарственно-индуцированная сердечная недостаточность развивается на фоне использования блокаторов кальциевых каналов (верапамил, дилтиазем, нифедипин), бета-блокаторов (пропранолол), антиаритмических (дизопирамид, дронедарон, лидокаин, лоркаинид, мексилетин, морицизин, пропафенон, токаинид, флекаинид, энкаинид), гипогликемических препаратов (росиглитазон, пиоглитазон, саксаглиптин), антрациклинов (доксорубицин, эпирубицин) и других противоопухолевых средств (бевацизумаб, инфликсимаб, трастузумаб), нестероидных противовоспалительных средств (диклофенак, ибупрофен, целекоксиб, рофекоксиб и др.). Предполагается, что эта патология развивается у небольшого числа пациентов, в основном уже имеющих дисфункцию левого желудочка. Тем не менее воздействие лекарственных средств следует рассматривать как одну из потенциально возможных и предотвратимых причин развития/прогрессирования сердечной недостаточности. Осведомленность медицинских работников о потенциальном неблагоприятном действии на сердечную деятельность отдельных представителей или целых фармакологических групп лекарственных средств, особенно у пациентов с имеющимся нарушением функции левого желудочка, может способствовать своевременной диагностике и профилактике лекарственно-индуцированной сердечной недостаточности.

сердечная недостаточность, лекарственно-индуцированная сердечная недостаточность, блокаторы кальциевых каналов, бета-блокаторы, антиаритмические препараты, гипогликемические препараты, антрациклины, противоопухолевые средства, нестероидные противовоспалительные средства

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