Хронічна серцева недостатність як мульти- морбідний стан
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Анотація
Велике значення у клінічному перебігу хронічної серцевої недостатності мають регуляторні та структурно-функціональні порушення з боку інших органів і систем, зокрема нирок, печінки, судин, скелетних м’язів, головного мозку. Зазначені порушення, з одного боку, можуть бути наслідком передіснуючих патологічних станів (артеріальна гіпертензія, цукровий діабет, гіпо- або гіпотиреоз тощо), а з другого боку – свідчити про патофізіологічні зміни, які прогресують, властиві самій по собі хронічній серцевій недостатності. Клінічно актуальними супутніми розладами при цьому синдромі зокрема є інсулінорезистентність і цукровий діабет, ниркова дисфункція, когнітивні й депресивні порушення, периферична міопатія. Для кожного з них характерна тісна патогенетична взаємодія з основним синдромом, наслідком якого є подальше погіршення клінічного прогнозу та якості життя пацієнтів. Облік коморбідних станів при реалізації рекомендованих стандартних підходів до фармакотерапії хронічної серцевої недостатності й використання додаткових терапевтичних засобів, спрямованих на їх подолання, втілює сучасну стратегію персоніфікованого лікування таких пацієнтів.
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