miokardiumis infarqti ST-segmentis elevaciis gareSe /arastabiluri ...

eta-blokerebis xmarebis ukuCvenebebia: pirveli (>24ms), II-III xarisxis
atrioventrikuluri blokada, asTma, mZime marcxena parkuWovani ukmarisoba,
sinusuri bradikardia ( < 50 ze) , hipotenzia (sistoluri wneva < 90 ze).
kalciumis arxebis antagonistebi
arian koronarebis dilatatorebi, maTi erTi nawili upiratesad moqmedebs
periferiul sisxlZarRvebze da iwvevs maT dilatacias (dihidropiridinebi).
meore nawili moqmedebs gulze da amcirebs gulis SekumSvaTa sixSires, zrdis
atrioventrikuluri gatarebis dros (verapamili, dilTiazemi). kvlevebis mixedviT
ar iqna nanaxi am jgufis preparatebis sasikeTo gavlena daavadebis gamosavalze,
piriqiT dihidropiridinebi zrdian garTulebebs Tu gamoiyenebian betablokerebis
gareSe. am jgufis preparatebis gamoyenebis Cvenebebi mocemulia
qvemoT.
rekomendaciebi
klasi I
1. woliTi reJimi pacientebSi, romelTac aReniSnebaT mosvenebis stenokardia.
iSemiisa da ariTmiis aRmosaCenad saWiroa uwyveti ekg monitoringi;
2. sublingvaluri da SemdgomSi intravenuri NTG-i iSemiis da masTan
dakavSirebuli simptomebis swrafi moxsnisaTvis;
3. Jangbadis micema pacientTaTvis cianoziT an respiratoruli distresiT.
TiTis puls-oqsimetri, raTa ganisazRvros adeqvaturia Tu ara
oqsigenizacia (SO2 > 90%-ze.) da Jangbadis miwodebis gagrZelebis saWiroeba;
4. intravenurad morfinis sulfati, rodesac simptomebi ar ixsneba NTG-iT an
saxezea mwvave pulmonaruli Segubeba;
5. beta-blokerebi, mimdinare tkivilis dros pirveli doza intravenurad,
xolo Semdgomi peroralurad, ukuCvenebebis ararsebobisas;
6. aradihidropiridinis jgufis kalciumis antagonisti (mag. verapamili an
dilTiazemi) marcxena parkuWis mZime disfunqciis an sxva ukuCvenebebis
ararsebobisas pacientebSi, mimdinare da xSirad morecidive iSemiiT,
rodesac beta-blokerebi ukunaCvenebia;
7. ACE inhibitorebi, rodesac hipertenzia persistirebs miuxedavad NTG-iT da
beta-blokebiT mkurnalobisa pacientebSi: LV sistoluri disfunqciiT an
CHF-iT da ACS-s dros pacientebSi, romlebsac aqvT diabeti.
klasi II A
1. peroraluri gaxangrZlivebuli moqmedebis kalciumis antagonistebi
recidiuli iSemiis dros, ukuCvenebaTa ararsebobisas da rodesac betablokerebi
da nitratebi sruladaa gamoyenebuli;
2. ACE inhibitorebi yvela pacientebSi ACS-s Semdgom.
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