INSUFICIENCIA CARDÍACA:

UN ENFOQUE MULTIDISCIPLINAR

José López Castro (coordinador)

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Prólogo
'H¿QLFLyQ y concepto
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Etiología
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Fisiopatología
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Clínica e indicadores de calidad
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Diagnóstico
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Tratamiento
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Pronóstico
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Particularidades de la IC en nuestro medio
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Buena práctica clínica en el manejo diagnóstico y
tratamiento de la IC. Errores evitables
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Plan de cuidados de enfermería para pacientes con IC
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Anexo I: Recomendaciones al paciente con IC
Bibliografía 
Anexo II: Ilustraciones a color 
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FISIOPATOLOGÍA

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2. OBJETIVOS DEL TRATAMIENTO DE LA IC

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2.1 MANEJO NO FARMACOLÓGICO

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GHMHHOKiELWRWDEiTXLFRRULHQWiQGRORFRQWHUDSLDVGHVXVWLWXFLyQ
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x Actividad sexual:6HUHFRPLHQGDFRQWLQXDUFRQDFWLYLGDG
VH[XDOFRQODSDUHMDKDELWXDOGHDFXHUGRFRQODDFWLYLGDGTXHOH
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SURGXFHQDUULWPLDVWDEOD9YHUSiJLQD

2.2 TRATAMIENTO FARMACOLÓGICO

2.2.1 IC con disfunción sistólica (tabla IX, página 73)

/RVIiUPDFRVPiVXWLOL]DGRVHQHOWUDWDPLHQWRGHOD,&\VXV
LQGLFDFLRQHV VH UHFRJHQ HQ OD WDEOD 9, SiJLQD  6XV LQGLFD
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Bloqueo neurohumoral
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/RV,(&$WDEOD9,,SiJLQDFRQVWLWX\HQXQSLODUEiVLFR
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YHVPRGHUDGRVRJUDYHVFRQRVLQHQIHUPHGDGLVTXpPLFD
/RVLQKLELGRUHVGHORVUHFHSWRUHVGHDQJLRWHQVLQD,,$5$,,
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Antagonistas de la aldosterona
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,,WUDVVXIULUXQLQIDUWRGHPLRFDUGLRFRQGLVIXQFLyQVLVWyOLFDDXQ
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PD\RUHVGHPJG/1RGHEHQVHUXWLOL]DGRVFRPRGLXUpWLFRVHQ
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(VSUHFLVRFRQWUROHVGH.DODVHPDQD\FDGDPHVHVOOHJDQGR
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Asociación de IECA, ARA II y/o antagonistas de

aldosterona
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\DWUDWDGRVFRQ,(&$$5$,,\EHWDEORTXHDQWHVDVtFRPRDORV
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XWLOL]DUHVWHEORTXHRLQWHQVRGHO65$$GHEHFXLGDUVHHOFRQWURO
GHHOHFWUyOLWRV\ODIXQFLyQUHQDO

Diuréticos
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UHQDO /RV GLXUpWLFRV GH DVD IXURVHPLGD WRUDVHPLGD DFW~DQ HQ
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Digital
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DVRFLDGRVDEHWDEORTXHDQWHVQRUHHPSOD]iQGRORV\HQOD,&VLQ
WRPiWLFDGHFXDOTXLHUJUDGRTXHQRKDPHMRUDGRFRQORVWUDWDPLHQ
WRVGHSULPHUQLYHO1RGLPLQX\HODPRUWDOLGDGSHURGLVPLQX\H
HOQ~PHURGHLQJUHVRV\PHMRUDODFDOLGDGGHYLGD/DVGRVLVGH
WUDWDPLHQWRUHFRPHQGDGDVFRQGLJR[LQDVRQGHPJGLDULRV
\QRSDVDQGRGHQLYHOHVHQSODVPDGHQJPO\DTXHVHREVHUYD
XQDPD\RUPRUWDOLGDGHVSHFLDOPHQWHHQDQFLDQRV\PXMHUHV

Hidralazina-dinitrato de isosorbide
(QFDVRGHLQWROHUDQFLDDORV,(&$$5$,,RLQVX¿FLHQFLD
UHQDOHVWDDVRFLDFLyQGHIiUPDFRVKDPRVWUDGRXWLOLGDGUHGXFLHQGR
ODPRUWDOLGDG\PHMRUDQGRODFDOLGDGGHYLGD

Antagonistas del calcio

(ODPORGLSLQR\IHORGLSLQRTXHQRWLHQHQDFFLyQQHJDWLYDVR
EUHODFRQWUDFWLOLGDGROD)&SXHGHQXVDUVHSDUDFRQWUROGHOD3$
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VHUGHXWLOLGDGHQHOFRQWUROGHORVVtQWRPDVGHORVSDFLHQWHVFRQ
GLVIXQFLyQGLDVWyOLFDVLELHQKD\TXHWHQHUVLHPSUHHQFXHQWDTXH
ORVEHWDEORTXHDQWHVGHEHQVHUODSULPHUDUHFRPHQGDFLyQIDUPD
FRWHUDSpXWLFDDOFRQWDUFRQHOEHQH¿FLRDxDGLGRGHSUHYHQFLyQGH
PXHUWHV~ELWD

Nitratos
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Antitrombóticos
/DDQWLFRDJXODFLyQFRQGLFXPDULQLFRVHVWiLQGLFDGDHQWRGR
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TXHUHGXFHQODPXHUWHV~ELWD

2.2.2 Tratamiento farmacológico de la IC con disfunción

diastólica
6HGHEHQLGHQWL¿FDU\FRUUHJLUORVIDFWRUHVSUHFLSLWDQWHV6RQ
HVSHFLDOPHQWH VHQVLEOHV D OD GHVFRPSHQVDFLyQ SRU )$ \ GHEH
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SHURVHGHEHVHUPX\FXLGDGRVRFRQHOXVRGHGLXUpWLFRVSDUDQR
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~WLOHVDOUHGXFLUODIUHFXHQFLDFDUGLDFD\DXPHQWDUHOSHULRGRGH
OOHQDGRGLDVWyOLFR\VHSXHGHQHPSOHDUWDPELpQHQHVWDVLWXDFLyQ
FOtQLFDORVDQWDJRQLVWDVGHOFDOFLRFRPRYHUDSDPLORVLHQGRXQD
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FRQGLVIXQFLyQVLVWyOLFDFRPRGLDVWyOLFDFRQODVLQGLFDFLRQHVTXH
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2.3 TRATAMIENTO QUIRÚRGICO. MARCAPASOS.

RESINCRONIZACIÓN CARDIACA

/D FLUXJtD SXHGH HVWDU LQGLFDGD SDUD FRUUHJLU DOJXQD GH ODV
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VLVWyOLFDLQGXFHGLVLQFURQtDYHQWULFXODU\SXHGHDJUDYDUORVVtQ
WRPDV

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FRQ,&FRQ)(GHOFRQ456•PV\TXHQRPHMRUDQ
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PRONÓSTICO

M. Pérez de Juan Romero

,QWHQWDUGH¿QLUHOSURQyVWLFRGHOD,&HVGLItFLO\FRPSOHMRSRU
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GHOD,&\SRU~OWLPRODGLIHUHQWHH¿FDFLDGHORVWUDWDPLHQWRVGH
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FDUGtDFRRODLPSODQWDFLyQGHXQGLVSRVLWLYRPHFiQLFR

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2. Hallazgos clínicos
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4. Valoración funcional durante el ejercicio

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5. Pruebas sanguíneas
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ULFR EDMR FUHDWLQLQD VpULFD DOWD ELOLUUXELQD VpULFD DOWD DQHPLD
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6. Pruebas hemodinámicas
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FLFRDXPHQWDGR

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PARTICULARIDADES DE LA IC EN NUESTRO MEDIO

J. López Castro

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x 3URJUHVLYRDEDQGRQRGHORVJUXSRVGHSREODFLyQSHTXHxRV
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GRQGH HO SRUFHQWDMH GH SREODFLyQ PD\RU GH  DxRV DOFDQ]D HO

x &RPR FRQVHFXHQFLD GH HVWH SURFHVR GH HQYHMHFLPLHQWR OD
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SDWRORJtDVFUyQLFDV\GHJHQHUDWLYDV\ODGLVSHUVLyQGHHVWHVHFWRU
GHODSREODFLyQLPSOLFDTXHODVPHGLGDVDVLVWHQFLDOHVFRUUHFWRUDV
VXSRQJDQXQPD\RUHVIXHU]RHFRQyPLFR
x /D HYROXFLyQ GH OD WDVD GH QDWDOLGDG \ PRUWDOLGDG 
\  UHVSHFWLYDPHQWH SRU  KDEV HVWi SURGXFLHQGR XQ
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