#61
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Äîáðûé äåíü!
Ê ñîæàëåíèþ, ìíå ïðèéäåòñÿ ñïðîñèòü ïðî qt... Ãèíåêîëîã ïîñòàâèëà ÑÏÊß è íàçíà÷àåò ãîðìîíû, â ò÷ ßðèíó, êîòîðàÿ ñíèæàåò óðîâåíü òåñòîñòåðîíà. Ó ìåíÿ îí íåìíîãî ïîâûøåí (0.800 ìêã/ë) ×èòàëà î âëèÿíèè ïîëîâûõ ãîðìîíîâ íà QT. Î òîì, ÷òî ýñòðîãåí åãî âåðîÿòíî óäëèíÿåò, òåñòîñòåðîí óêîðà÷èâàåò. Ìîæåò ëè â ìîåì ñëó÷àå áûòü íå áåçîïàñíûì ïðèåì ãîðìîíîâ? Ñïàñèáî! |
#62
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ïîæàëóéñòà, ñïðàøèâàéòå - âñå âàøè ÷òåíèÿ ïóñòû è íàïðàâëåíû íà óñèëåíèå ñâîèõ ñîáñòâ. ôîáèé: åñëè áû òà ÷óøü áûëà âåðíîé, òî âûæèâàëè ëèøü ìóæ÷èíû, à æåíøèíû óìèðàëè ïîñëå ïîëîâîãî ñîçðåâàíèÿ, â Âàøåé ñèòóàöèè - ÍÅáåçîïàñíî ÷òåíèå òûðíåòà ïî ìåä. âîïðîñàì, ïî÷èòàéòå ëþáîâíûé ðîìàí ñ õîðîøèì êîíöîì
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#63
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Äîáðûé äåíü! Ýòî ñíîâà ÿ... è ÿ î÷åíü èçâèíÿþñü, íî ñèòóàöèÿ ìåíÿ ñàìà íå îòïóñêàåò. Ìíå íàïèñàëà ãåíåòèê, ÷òî ìîÿ ìóòàöèÿ èçìåíèëàñü íà ïàòîãåííóþ [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] ïðîèçîøëî ýòî ïîñëå ïîëó÷åíèÿ ðåçóëüòàòîâ, â êîíöå ãîäà
Ýòî ìåíÿåò ÷òî òî â òàêòèêå? |
#64
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äà, âàì íóæíî îáðàòèòüñÿ ê î÷íîìó êàðäèîëîãó è ïîëó÷èòü ðåêîìåíäàöèè, êîòîðûì âû áóäåòå ñëåäîâàòü, à îí/îíà íåñòè îòâåòñòâåííîñòü çà ðåêîìåíäîâàííîå, åòî ïîñëåäíåå ïðåäóïðåæäåíèå ïåðåä çàêðûòèåì òåìû è áàíîì, åñëè ó âàñ áóäóò ñîìíåíèÿ, ïî ïîâîäó òàêèõ ðåêîìåíäàöèé - âûêëàäûâàéòå ñêàí è ñêàçó, ñîîòâ. ëè îíè ïðàêòèêå èëè íåò, ëþáîé äðóãîé ôîáè÷íûé âîïðîñ ïðèâåäåò ê çàêðûòèþ òåìû, ñïàñèáî çà âàøå ïîíèìàíèå. Ìîäåðàòîð
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#65
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ïîæàëóéñòà, çàêðûâàéòå òåìó, åñëè ñ÷èòàåòå íóæíûì. Íî êàêèå ïðàâèëà íàðóøåíû - íå èìåþ ïîíÿòèÿ. Êîíêðåòíûé âîïðîñ ïî êîððåêòíîìó ñëó÷àþ. Áåç íûòüÿ, áåç ïàíèêè, ïî äåëó.
Äóáëèðóþ ðåêîìåíäàöèè àðèòîìîëîãà èç Ñå÷åíîâà, ïîñëå òåëåêîíñóëüòàöèÿ. "ìîæíî ïðèíèìàòü áåòà-áëîêàòîð (áåòàëîê çîê, êîðãàðä) â íåáîëüøîé äîçå(2,5-5ìã) íà ïîñòîÿííîé îñíîâå, åñëè ïî÷óâñòâóåòå êàêèå-ëèáî ïåðåáîè ðèòìà, åãî ó÷àùåíèå è ïðè îòñóòñòâèè áðàäèêàðäèè. Àáñîëþòíûõ ïîêàçàíèé ê ïðèåìó íåò, öåëåñîîáðàçíîñòü ïðè îòñóòñòâèè ïðîòèâîïîêàçàíèé âîçìîæíà (ò.å., êëàññ ïîêàçàíèé IIÀ)." |
#66
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Ñîãëàñåí ñ åãî ìíåíèåì, äîáàâëþ ñ òî÷êè çðåíèÿ ìèðîâûõ åêñïåðòîâ, ÷òî ïðåïàðàò âûáîðà, åñëè ðåøèòåñü íà á-áëîêåð, íàäîëîë è/èëè ïðîïðàíîëîë-ðåòàðä ïðåäïî÷òèòåëüíåå (íå çíàþ òåõ êîìì. íàçâàíèé â ÐÔ), íà÷èíàþò ñ ìàëîé äîçû è ïîñòåïåííî óâåëè÷èâàþò äî öåëåâîé
nadolol (Corgard) and propranolol (Inderal LA, InnoPran XL) Nadolol is the first choice, starting with a low dose and then up-titrating to 1 mg/kg
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#67
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ïîíÿëà, ñïàñèáî! Ïîêà çàéìóñü ñâîèìè íåðâàìè, åñëè ìîÿ êàðäèîãðàììà óëó÷øèòñÿ îò ýòîãî - îáÿçàòåëüíî ïîäåëþñü.
Åñëè íåò, íàâåðíîå, ñÿäó íà áëîêàòîðû. Êàê ÿ ïîíÿëà ðåøàòü òóò áîëüøå ìíå, ðàç êëàññ - ðåêîìåíäîâàíî Êñòàòè, çàáûëà ïðî ôåððèòèí ñêàçàòü, ÷òî ÿ åãî åùå ìåñÿö íàçàä ñäàëà - ïîäíÿëñÿ äî 70. Âèäèìî áûñòðî è õîðîøî óñâîèëñÿ. Ïðèåì çàâåðøèëà. |
#68
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õîðîøî, öèôðà ôåððèòèíà 50-70 - îïòèìàëüíàÿ äëÿ æåíøèí äëÿ íàèáîëüøåé ïðîäîëæèòåëüíîñòè æèçíè, îñòàâëþ âàì çäåñü ññûëêó íà íàçíà÷åíèå íàäîëîëà è ïîòîì âûïîëíåíèå ñòðåññ-òåñòèðîâàíèÿ (íå çíàþ åòî â ðàìêàõ êëèí. èññëåäîâàíèÿ èëè ïðàêòèêóþò âñåì â îòäåëüíûõ êëèíèêàõ çà ðóáåæîì), íî òàì ñðåäíÿÿ äîçà íàäîëîëà áûëà 0.7-0.8 ìã/êã è âñåãî ~0.5 ìã/êã ñ ïîâûøåííûì îòâåòîì è ~1.0 ìã/êã ñ ïîíèæåííûì îòâåòîì, îáñóäèòå ñî ñâîèì âðà÷îì íóæíû ëè âàì òàêîå òåñòèðîâàíèå è êîððåêòèðîâêà äîçû ñî âðåìåíåì:
The average dose of nadolol received by over-responders was 0.46±0.1 mg/kg, whereas the average dose received by under-responders was 1.05±0.3 [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#69
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Óëó÷øåííàÿ ÝÊÃ âûÿâëåííûé ãåí íå îòìåíèò.
Ïðèìèòå äëÿ ñåáÿ ðåøåíèå: íà÷èíàòü íàäîëîë èëè íåò? È äîñòóïåí ëè îí Âàì, Âû æå â Ðîññèè? È ñíèæàéòå òðåâîãó. Ðîæàéòå è æèâèòå ïîëíîé æèçíüþ. QT íåïðèÿòíî, íî ýòî íå ãàðàíòèÿ ÷åãî-òî, à ëèøü íåêàÿ âåðîÿòíîñòü. Ðàç ãåí ñâåæèé, òî âåðîÿòíîñòü íå ñèëüíî âûñîêàÿ. Ñàìûå ãðóñòíûå ãåíû èçâåñòíû ñ ïðîøëîãî âåêà, ó Âàñ èõ íåò. Íå çíàþ êàê åùå óãîâîðèòü Âàñ äîæèòü ñïîêîéíî äî êëèìàêñà?..
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Àëåêñàíäð Èâàíîâè÷ ñ ïîæåëàíèÿìè êðåïêîãî çäîðîâüÿ |
#70
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ñïàñèáî, Àëåêñàíäð Èâàíîâè÷
ß óæå ïî÷òè ïåðåñòàëà òàê ïàíèêîâàòü. Ðåøåíèå ïðèìó. òóò åñòü àíàïðèëèí(ïîïðàíîëîë) è àòåíîëîë, íàïðèìåð Íàäîëîë êàêîé òî çîëîòîé, íàçûâàåòñÿ òóò Êîðãàðä è ñòîèò 5000 çà óïàêîâêó, íå ñòðàøíî , íî âèäàòü íå âñåãäà îí åñòü â àïòåêàõ |
#71
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Àëåêñàíäð Èâàíîâè÷ ñ ïîæåëàíèÿìè êðåïêîãî çäîðîâüÿ |
#72
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íåò íà îáà ïðåïàðàòà, èõ íàçíà÷åíèå ìîæåò íå çàøèòèòü âàñ, äîêòîð î÷íûé âàì ïðÿìî íàïèñàë áåòàëîê-çîê - ïðîëîíãèð. ïðîïðàíîëîë, íå àíàïðèëèí! åñëè íåò íè÷åãî èëè íå îñèëèâàåòå ôèíàíñîâî, òî êóïèòü áàðàõëî è äóìàòü ÷òî òîæå âàñ çàøèòèò - íàèâíî
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#73
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#74
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âîò òàêàÿ ñòàòüÿ ïðî ñèíäðîì è áåðåìåííîñòü - ïèøóò, ÷òî ÁÁ íóæåí
Prenatal Recommendations in Long QT Syndrome Once pregnancy is confirmed in a woman with LQTS, a management plan for pregnancy and the 9-month postpartum period should be made in collaboration with the obstetrician and cardiologist with ongoing review and discussion throughout. Women should be educated and counseled on potential triggers of LQTS cardiac events including avoidance of hypokalemia and QT-prolonging drugs, which can be checked on the Credible Meds website. Several recommendations regarding the management of pregnant patients with LQTS have been included in other guidelines.18 An ECG should be performed at each visit to evaluate the corrected QT interval. Electrolytes and vitamin D levels should be monitored as mild hypomagnesemia and vitamin D deficiency are common during pregnancy and could put the mother and fetus at avoidable risk. Encouraging increased potassium and magnesium intake is reasonable. A maternal-fetal medicine specialist with expertise in the prenatal diagnosis and care of fetal LQTS can assist parents during the prenatal period. Likewise, early referral to a pediatric cardiologist familiar with LQTS will help expedite screening of the newborn and preventive therapy in the event that the baby is diagnosed with congenital LQTS. Management of Women with Long QT Syndrome During Pregnancy Treatment with a β-blocker is indicated to reduce risk of cardiac events and sudden cardiac death.14,18–20 Guidelines for management of ventricular arrhythmias and prevention of sudden cardiac death strongly recommend that in women with LQTS, a β-blocker should be continued during pregnancy and the postpartum period regardless of symptoms, including while breastfeeding.18 Arrhythmic events during pregnancy are not increased among women receiving β-blocker therapy.11,12,14,19 In contrast, in a case-control study, women with LQT1 who did not receive β-blockers during pregnancy were at increased risk of cardiac arrest or syncope.13 In at least one study, increased risk for cardiac events in the high-risk postpartum period was significantly reduced by β-blockers.14 Not all β-blockers are equally effective in LQTS (Table 1).21 In general, non-selective β-blockers, such as nadolol and propranolol, are preferred over the β1-selective agents, such as metoprolol. Documented evidence, however, is largely lacking comparing specific agents in LQTS during pregnancy and lactation. Most data are primarily limited to isolated small case reports. Nadolol titrated to a recommended dose of 1–1.5 mg/kg/day is prescribed for LQTS by the majority of electrophysiologists as it is the most effective β-blocker for the syndrome, especially in high-risk individuals.22,23 The longer half-life of nadolol compared with other β-blockers also gives it an advantage for LQTS. However, data supporting the use of nadolol in pregnancy are limited. Nadolol is highly excreted in breastmilk and infants exposed to nadolol via breast milk should be monitored for side-effects, such as bradycardia, lethargy, poor feeding or weight gain. Propranolol or bisoprolol appear to have acceptable efficacy and safety profiles in LQTS and during pregnancy and lactation.24,25 Management of Long QT Syndrome in Women Before, During, and After Pregnancy [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#75
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Öèòàòà:
Ïåðåä ãëàçàìè êîðîáêà "àíàïðèëèíà" è íà íåé íàïèñàíî - "ïðîïðàíîëîë" "Àòåíîëîë" íàçíà÷àåò Ìàêàðîâ äåòêàì â ÌÔÁÀ ñèíêîïàëüíûõ ñîñòîÿíèé ï.ñ. ýòî ÿ íå ïîñïîðèòü, ïðîñòî â ðàìêàõ äèàëîãà |