我阿爸既小腿水腫得好西利

請問西醫點樣醫心臟衰竭？
咪咪又喺睇住病人慢慢衰竭而死

中醫係整體機能改善，調理身體，唔係逐樣做。

我係美國
唔係香港

ACEI/ ARB / entresto
SGLT2
Beta blocker
Aldactone
加利尿藥去水
大路都係呢啲，以上全部有晒數據證明有效

我自己都尊重中醫，亦唔反對病人搵中醫
現代醫學係有數據嘅就俾到你，無能為力就無辦法
但係唔好講到心臟衰竭喺現代醫學只係睇住個病人慢慢衰竭而死咁簡單

食醫院野咪沒事

我就覺得要戒囉

入靈實 唔係好大穫就係咩㗎咩

你呢個似osa多

我舉個例，佢長期身體個血壓上壓都係160，keep 住5年咁過日常生活。食完藥，去返120，呢個係我哋行住街嘅血壓。但對佢嚟講係血壓跌咗40度，習慣唔到係合理。如果佢係有幾隻血壓藥嘅，分開唔同時段食，早餐食A藥，晚餐前食B藥咁。如果得一隻藥，可以出矛招，一粒藥切一半分開上下晝食，到習慣到先再一次食返足一粒。個原理都係俾佢唔好一下跌40度，而係20/20咁跌。

只可以講啲drug choice有啲奇怪

通常血壓藥會用ACE inhibitors e.g. ramipril 因為佢哋會令到腎嘅血管擴張 所以可以同時降到血壓同保護到個腎
有研究prove咗ACEi reduces mortality in HF patients 所以除非血壓真係太低 正常都會prescribe
Terazosin係alpha blocker 降血壓嘅作用冇ACEi, ARB, CCB咁勁

知唔知點解醫生冇開利尿藥? 其中一個氣喘原因有機會係心藏周圍太多水影響抖氣 個心跳得唔夠力 啲水就容易積喺對腳甚至乎嗰肺到 所以利尿藥好重要
最常見係furosemide 同 spironolactone Spironolactone有機會幫到心臟泵血

另外一隻常見嘅heart failure藥係beta blocker e.g. bisoprolol 呢隻藥可以減低心跳令個心冇咁攰

如果太差通常都會加隻糖尿藥叫dapagliflozin 未知點解會work 但係數據發現會明顯降低死亡率

點解要食tramadol? Tramadol始終係鴉片類藥物 食得多有機會上癮

你呀爸以前有冇試過/高風險會心臟病或中風? 有冇高膽固醇
如果以上階非 你呀爸又80歲以上 其實statin可有可無

有機會係你呀爸tolerate唔到呢隻血壓藥 solution就係轉藥

亦都有機會係嗰dose titrate up太快 個身適應唔到 solution就係食低啲dose先 tolerate到再increase dose dose titration有時要慢慢嚟

佢有冇食其他藥

食咁多藥唔死都偷笑

笑死 食西藥食到就快死都冇問題 你都幾好耶

其實我呀爸隻腳水腫都超過3年，本身都有高血壓

你上clinical pharmacology
Hydralazine 同Simvastatin 會令病人有nerve pain
可能因為咁醫生先開tramadol 同gabapentin

Possible but not definite, especially when neuropathy is a rare side effect of both drugs.
Nerve pain could also be caused by diabetic neuropathy. If that’s the case, duloxetine may be a better treatment option.

You never know if you don’t ask.

Tramadol should not be used long term as its potential for abuse and dependence.
Tramadol is not a particularly nice drug for elderly because
1. Can increase risk of fall (by causing dizziness and drowsiness but these may improve over time as the body adjusts to the effects of the medication),
2. Can increase risk of GI bleed/ulcers,
and
3. Can increase risk of urinary retention (hence fluid retention which is not ideal for HF).
That’s why I wanted to find out why his on tramadol.

同意，冇lasix冇beta blocker好奇怪

連登 telehealth

Medical record 都唔洗睇

唔考慮下樓主呢 d 盲毛上網睇完一堆好似好高深但自己完全唔明嘅"專業意見"之後下次見醫生會講咩

加上唔合作嘅 patient

討論區就喺要黎討論架啦
上面堆留言都話好多嘢都唔肯定又無血報告都係比少少意見姐
咁易踩親你條尾 你就喺開藥個醫生？

你地覺得 appropriate 咪俾多 d 意見囉

又唔係我老豆

有冇驗血check肝功能

白蛋白低會水腫

你爸爸係咪個腎都唔得？心衰竭無可能無ACEI, 糖尿病又無metformin…心同腎一齊炒仲唔戒口真係神仙都難救

改完藥比佢出院果期都係有啲腫
係加埋按湧泉穴就好好多
所以佢淨係依家戒鹹野 但無限水由佢飲

冇得解決