Obsah fóra poradna o diabetes (= cukrovka) poradna o diabetes (= cukrovka)
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Autonomní neuropatie

 
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Klára



Založen: 10.12.2008
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PříspěvekZaslal: pá duben 24, 2009 11:49 am    Předmět: Autonomní neuropatie Citovat

Dobrý den, léčím se pro DM1.typu, pracuji jako zdravotní sestra. Byla mi diagnostikována autonomní neuropatie kardiovaskulárního aparátu s tachykardií a ortostatickou hypotenzí. Měla bych jít na zavedení terapie, ráda bych zkonzultovala, která skupina je v tomto případě lepší, zda betablokátory či blokátory vápníkového kanálu, příp. jaký je rozdíl v jejich indikaci. Velmi děkuji.
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Klára



Založen: 10.12.2008
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PříspěvekZaslal: st duben 29, 2009 8:27 am    Předmět: Citovat

Dobrý dem, opravdu nikdo nemáte s tímto problémem zkušenost? Moc by mi to pomohlo, kdyby jste mi tu poradili:-)
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MUDr. Dagmar Málková



Založen: 26.11.2008
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PříspěvekZaslal: st duben 29, 2009 8:38 am    Předmět: Citovat

Dobrý den,
předpokládám,že diabetem trpíte již dlouho,když Vám byla diagnostikována autonomní neuropatie.
Uvádíte ,že trpíte ortostatickou hypotenzí a tachykardií.
V tomto případě je důležité,jakou metodou Vám byly obtíže zjištěny/ nejčastěji spektrální analýza variability tepové frekvence,Ewingova baterie testů,Valsalvova zkouška,ortostatická zkouška,handgrip test,atd../.
Pojem tachykardie je velmi široký a nelze jen takto určit vhodnou terapii.Nejčastější uváděné poruchy rytmu jsou -snížení respirační sinusové arytmie,snížení variability TF v zátěžových situacích,klidová tachykardie,porucha baroreflexních odpovědí,ztráta cirkadiálního rytmu variability TF a TK.
Při přesném určení typu arytmie lze cílit medikaci.Nejčastěji,jak sama víte,se užívají betablokátry a blokátry Ca kanálu.Medikace se tedy dává cíleně na přesný typ arytmie,mnohdy je nutno vyzkoušet obě lékové skupiny,do úlevy obtíží nemocného.
Paušálně se zkusmo nasazují betablokátory / pokud není závažná KI jako bronchospasmus,poruchy rytmu ve smyslu bradykardie a další.
Medikaci Vám nasadí diabetolog / užívají se nejčastěji Concor cor a Isoptin jako zástupce druhé skupiny/,pokud je to závažnější typ arytmie,je vhodná konsultace s kardiologem.
S pozdravem
MUDr. Dagmar Málková
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