Akut kalp yetersizliğine algoritmalarla pratik yaklaşım

YILMAZ, MEHMET BIRHAN; ZOKHİ, Mehdi; Nalbantgil, Sanem; Çavuşoğlu, Yüksel; Eren, Mehmet; MEBAZAA, Alexadre

Akut kalp yetersizliğine algoritmalarla pratik yaklaşım

Mehdi ZOKHİ, (Ege Üniversitesi, Tıp Fakültesi, Kardiyoloji Anabilim Dalı, İzmir, Türkiye)

Yüksel ÇAVUŞOĞLU, (Osmangazi Üniversitesi, Tıp Fakültesi, Kardiyoloji Anabilim Dalı, Eskişehir, Türkiye)

Mehmet Birhan YILMAZ, (Cumhuriyet Üniversitesi, Tıp Fakültesi, Kardiyoloji Anabilim Dalı, Sivas, Türkiye)

Sanem NALBANTGİL, (Ege Üniversitesi, Tıp Fakültesi, Kardiyoloji Anabilim Dalı, İzmir, Türkiye)

Mehmet EREN, (Dr. Siyami Ersek Göğüs Kalp ve Damar Cerrahisi Eğitim ve Araştırma Hastanesi, İstanbul, Türkiye)

Alexadre MEBAZAA (Department, of Anaesthesiology and Critical Care Medicine, Hospital Lariboisiere, Paris, France)

Anadolu Kardiyoloji Dergisi

1 0

Yıl: 2009 Cilt: 9 Sayı: 6 Sayfa Aralığı: 436 - 446 Metin Dili: Türkçe İndeks Tarihi: 29-07-2022

Akut kalp yetersizliğine algoritmalarla pratik yaklaşım

Öz:

Akut kalp yetersizliği (AKY) sendromu heterojen bir grup olup farklı tedavi yaklaşımları gerektirmektedir. Yüksek kan basıncı olan hastalarda diüretik ve/veya vazodilatörler, düşük sol ventrikül ejeksiyon fraksiyonu ve hipoperfüzyon bulguları olanlarda ise daha çok inotropik ajanlar ön planda tutulmaktadır. Akut kalp yetersizliğinde doğru ve erken tanı, erken tedaviyi beraberinde getirerek mortaliteyi ve morbiditeyi önemli ölçüde azaltmaktadır. Dolayısıyla tüm hekimlerin kolaylıkla izleyebileceği algoritmaların oluşturulması önem taşımaktadır. Bu yazıda kalp yetersizliği kılavuzlarının ve ülkemizde bu alanda yapılan klinik çalışmaların verileri paralelinde, akut kalp yetersizliğinin farklı klinik tabloları için ülkemiz koşullarına uygun tedavi algoritmaları önerilmektedir.

Anahtar Kelime:

Konular: Kalp ve Kalp Damar Sistemi

Practical approach to acute heart failure with algorithms

Öz:

Acute heart failure syndrome is a heterogeneous group, which requires distinct therapeutic approaches. Diuretics and/or vasodilators for patients with high blood pressure and inotropic agents for patients with low left ventricular ejection fraction and evidence of hypoperfusion are kept in the forefront. Early initiation of therapy along with accurate and early diagnosis in acute heart failure reduces mortality and morbidity significantly. Therefore, it is critically important to develop algorithms, which could easily be followed by all physicians. In this paper, in parallelism with heart failure guidelines and utilizing data of the clinical studies, performed by colleagues of our country in this area, therapeutic algorithms compatible with the conditions of our country are suggested for distinct clinical presentations of acute heart failure.

Anahtar Kelime:

Konular: Kalp ve Kalp Damar Sistemi

Belge Türü: Makale Makale Türü: Diğer Erişim Türü: Erişime Açık

1. Fonarow GC. Epidemiology and risk stratification in acute heart failure. Am Heart J 2008; 155: 200-7.
2. Cleland JG, Swedberg K, Follath F, Komajda M, Cohen-Solal A, Aguilar JC, et al. The EuroHeart Failure survey programme- a survey on the quality of care among patients with heart failure in Europe. Part 1: patient characteristics and diagnosis. Eur Heart J 2003 ; 24: 442-63.
3. Collins SP, Storrow AB. Acute heart failure risk stratification: can we define low risk? Heart Fail Clin. 2009; 5: 75-83, vii.
4. Adams KF Jr, Fonarow GC, Emerman CL, LeJemtel TH, Costanzo MR, Abraham WT, et al. Characteristics and outcomes of patients hospitalized for heart failure in the United States: rationale, design, and preliminary observations from the first 100,000 cases in the Acute Decompensated Heart Failure National Registry (ADHERE). Am Heart J. 2005; 149: 209-16.
5. Nieminen MS, Böhm M, Cowie MR, Drexler H, Filippatos GS, Jondeau G, et al. Executive summary of the guidelines on the diagnosis and treatment of acute heart failure: the Task Force on Acute Heart Failure of the European Society of Cardiology. Eur Heart J 2005; 26: 384-416.
6. Fonarow GC, Abraham WT, Albert NM. Influence of a performance-improvement initiative on quality of care for patients hospitalized with heart failure: results of the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure (OPTIMIZE-HF). Arch Intern Med 2007;167: 1493-502.
7. HFSA 2006 Comprehensive Heart Failure Practice Guideline. J Card Fail. 2006; 12: e1-2.
8. Dickstein K, Cohen-Solal A, Filippatos G, McMurray JJ, Ponikowski P, Poole-Wilson PA, et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the diagnosis and treatment of acute and chronic heart failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur J Heart Fail 2008; 10: 933-89.
9. Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, et al. 2009 focused update incorporated into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation 2009 14; 119: e391-479.
10. Gheorghiade M, Abraham WT, Albert NM, Greenberg BH, O'Connor CM, She L, et al. Systolic blood pressure at admission, clinical characteristics, and outcomes in patients hospitalized with acute heart failure. JAMA. 2006; 296: 2217-26.
11. Zannad F, Mebazaa A, Juillière Y, Cohen-Solal A, Guize L, Alla F, et al. Clinical profile, contemporary management and one-year mortality in patients with severe acute heart failure syndromes: The EFICA study. Eur J Heart Fail 2006; 8: 697-705.
12. Mebazaa A, Nieminen MS, Packer M, Cohen Solal A, Keleber FX, Pocock SJ, et al. Levosimendan vs dobutamine for patients with acute decompensated heart failure: the SURVIVE Randomized Trial. JAMA 2007; 297: 1883-91.
13. Peacock WF, Hollander JE, Diercks DB, Lopatin M, Fonarow G, Emerman CL. Morphine and outcomes in acute decompensated heart failure: an ADHERE analysis. Emerg Med J 2008; 25: 205-9.
14. Mebazaa A, Gheorghiade M, Piña IL, Harjola VP, Hollenberg SM, Follath F, et al. Practical recommendations for prehospital and early in-hospital management of patients presenting with acute heart failure syndromes. Crit Care Med. 2008; 36(1 Suppl): S129-39.
15. Gheorghiade M, Pang PS. Acute heart failure syndromes. J Am Coll Cardiol. 2009; 53: 557-73.
16. Aras D, Topaloğlu S, Korkmaz Ş. Dekompanse kalp yetersizliği tedavisinde yeni bir inotropik ajan: Levosimendan. Türk Kardiyol Dern Arş 2007;35:48-56.
17. Duygu H, Özerkan F, Zoghi M, Nalbantgil S, Yıldız A, Akıllı A, et al. Effect of levosimendan on right ventricular systolic and diastolic functions in patients with ischaemic heart failure. Int J Clin Pract 2008; 62: 228-33.
18. Yılmaz MB, Yontar C, Erdem A, Karadaş F, Yalta K, Turgut OO, et al. Comparative effects of levosimendan and dobutamine on right ventricular function in patients with biventricular heart failure. Heart Vessels 2009; 24: 16-21.
19. Yılmaz MB. Levosimendan and ventriculo-arterial coupling. Acta Anaesthesiol Scand 2008; 52: 449.
20. Çavuşoğlu Y, Tek M, Birdane A, Ata N, Demirüstü C, Görenek B, et al. Both levosimendan and dobutamine treatments result in significant reduction of NT-proBNP levels, but levosimendan has better and prolonged neurohormonal effects than dobutamine. Int J Cardiol 2008; 127: e188-91.
21. Çavuşoğlu Y. The use of levosimendan in comparison and in combination with dobutamine in the treatment of decompensated heart failure. Expert Opin Pharmacother 2007; 8: 665-77.
22. Kaşıkçıoğlu HA, Uyarel H, Tartan Z, Kaşıkçıoğlu E, Öztürk R, Cam N, et al. Do calcium sensitizers affect right ventricular functions in patients with chronic heart failure? Int J Cardiol 2007; 118: 246-8.
23. Tatlıcıoğlu T. Kronik obstrüktif akciğer hastalığı (KOAH) ve geleceği. Tuberk Toraks 2007; 55: 303-18.
24. Peacock WF, Hollander JE, Diercks DB, Lopatin M, Fonarow G, Emerman CL. Morphine and outcomes in acute decompensated heart failure: an ADHERE analysis. Emerg Med J 2008; 25: 205-9.
25. Morrison LK, Harrison A, Krishnaswamy P, Kazanegra R, Clopton P, Maisel A. Utility of a rapid B-natriuretic peptide assay in differentiating congestive heart failure from lung disease in patients presenting with dyspnea. J Am Coll Cardiol 2002; 39: 202-9.
26. Eshaghian S, Horwich TB, Fonarow GC. Relation of loop diuretic dose to mortality in advanced heart failure. Am J Cardiol 2006; 97: 1759-64.
27. Chatti R, Fradj NB, Trabelsi W, Kechiche H, Tavares M, Mebazaa A. Algorithm for therapeutic management of acute heart failure syndromes. Heart Fail Rev. 2007; 12: 113-7.
28. De Luca L, Fonarow GC, Adams KF Jr, Mebazaa A, Tavazzi L, Swedberg K, et al. Acute heart failure syndromes: clinical scenarios and pathophysiologic targets for therapy. Heart Fail Rev 2007;12: 97-104.
29. Shin DD, Brandimarte F, De Luca L, Sabbah HN, Fonarow GC, Filippatos G, et al. Review of current and investigational pharmacologic agents for acute heart failure syndromes. Am J Cardiol 2007; 99 (2A Suppl): 4A-23A.
30. Emerman CL. Treatment of the acute decompensation of heart failure: efficacy and pharmacoeconomics of early initiation of therapy in the emergency department. Rev Cardiovasc Med 2003; 4 Suppl 7: S13-20.
31. Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG, et al. ACCF/AHA guidelines for the diagnosis and management of heart failure in adults. Circulation 2009; 119:1977-2006.
32. Hastillo A, Taylor DO, Hess ML. Specific positive inotropic agents. In: Messerli FH, editor. Cardiovascular Drug Therapy, 2nd ed.. Philadelphia; W.B. Saunders Company; 1996. p. 1151-61.
33. Murphy MB, Vaughan CJ. Dopamine. In: Messerli FH, editor. Cardiovascular Drug Therapy, 2nd ed.. Philadelphia; W.B. Saunders Company; 1996. p. 1161-6.
34. Leier CV, Heban PT, Huss P, Bush CA, Lewis RP. Comparative systemic and regional hemodynamic effects of dopamine and dobutamine in patients with cardiomyopathic heart failure. Circulation 1978; 58: 466-75.
35. Robie NW, Goldberg LI. Comparative systemic and regional hemodynamic effects of dopamine and dobutamine. Am Heart J 1975; 90: 340-5.
36. Leier CV, Binkley PF. Parenteral inotropic support for advanced congestive heart failure. Progr Cardiovasc Dis 1998; 41: 207-24.
37. Unverferth DV, Blanford M, Kates RE, Lier CV. Tolerance to dobutamine after a 72-hour continuous infusion. Am J Med 1980; 69: 262-6.
38. Metra M, Nodari S, D’Aloia A, Muneretto C, Robertson AD, Bristow MR, et al. Beta blocker therapy influences the hemodynamic response to inotropic agents in patients with heart failure: a randomized comparison of dobutamine and enoximone before and after chronic treatment with metoprolol or carvedilol. J Am Coll Cardiol 2002; 40: 1248-58.
39. Pacold I, Kleinman B, Gunnar R, Loeb HS. Effects of low-dose dobutamine on coronary hemodynamics, myocardial metabolism and anginal threshold in patients with coronary artery disease. Circulation 1983; 68: 1044-50.
40. O’Connor CM, Gattis WA, Uretsky BF, Adams KF Jr, McNulty SE, Grossman SH, et al. Continuous intravenous dobutamine is associated with an increased risk of death in patients with advanced heart failure: insight from the Flolan International Randomized Survival Trial (FIRST). Am Heart J 1999; 138: 78-86.
41. Abraham WT, Adams KF, Fonarow GC, Costanzo MR, Berkowitz RL, LeJemtel TH, et al. In-hospital mortality in patients with acute decompensated heart failure requiring intravenous vasoactive medication: an analysis from the Acute Decompensated Heart Failure National Registry (ADHERE). J Am Coll Cardiol 2005; 46: 57-64.
42. Slawsky MT, Colucci WS, Gottlieb SS, Greenberg BH, Haeusslein E, Hare J, et al. Acute hemodynamic and clinical effects of levosimendan in patients with severe heart failure. Circulation 2000; 102: 2222-7.
43. Nieminen MS, Akkila J, Hasenfuss G, Kleber FX, Lehtonen LA, Mitrovic V, et al. Hemodynamic and neurohumoral effects of continuous infusion of levosimendan in patients with congestive heart failure. J Am Coll Cardiol 2000; 36: 1903-12.
44. Gruhn N, Nielsen-Kudsk JE, Theilgaard S, Bang L, Olesen SP, Aldershvile J, et al. Coronary vasorelaxant effect of levosimendan, a new inodilator with calcium-sensitizing properties. J Cardiovasc Pharmacol 1998; 31: 741-9.
45. Pagel PS, Hettrick DA, Warltier DC. Influence of levosimendan, pimobendan, and milrinone on the regional distribution of cardiac output in anaesthetized dogs. Br J Pharmacol 1996; 119: 609-15.
46. Ukkonen H, Saraste M, Akkila J, Knuuti J, Karanko M, Iida H, et al. Myocardial efficiency during levosimendan infusion in congestive heart failure. Clin Pharmacol Ther 2000; 68: 522-31.
47. Packer M. REVIVE II: Multicenter placebo-controlled trial of levosimendan on clinical status in acutely decompensated heart failure. American Heart Asssociation Scientific Sessions 2005; November 13-16, 2005, Dallas, Texas. Late Breaking Clinical Trials II. Circulation 2005; 112: 3363.
48. Follath F, Cleland JG, Just H, Papp JG, Scholz H, Peuhkurinen K, et al. Efficacy and safety of intravenous levosimendan compared with dobutamine in severe low-output heart failure (the LIDO study): a randomized double-blind trial. Lancet 2002; 360: 196-202.
49. Mclean AS, Huang SJ, Nalos M, Ting I. Duration of the beneficial effects of levosimendan in decompensated heart failure as measured by echocardiographic indices and B-type natriuretic peptide. J Cardiovasc Pharmacol 2005; 46: 830-5.
50. Cavusoglu Y, Tek M, Demirustu C. Levosimendan may provide a better neurohormonal response in heart failure patients receiving beta blocker therapy- reply. Int J Cardiol 2008; 128: 94-96.
51. Lehtonen L, Sundberg S. The contractility enhancing effect of the calcium sensitizer levosimendan is not attenuated by carvedilol in healthy subjects. Eur J Clin Pharmacol 2002; 58: 449-52.
52. Janssen PM, Datz N, Zeitz O, Hasenfuss G. Levosimendan improves diastolic and systolic function in failing human myocardium. Eur J Pharmacol 2000; 404: 191-9.
53. Parissis J, Panou F, Farmakis D, Adamopoulos S, Filippatos G, Paraskevaidis I, et al. Effects of levosimendan on markers of left ventricular diastolic function and neurohormonal activation in patients with advanced heart failure. Am J Cardiol 2005; 96: 423-6.
54. Kersten JR, Montgomery MW, Pagel PS, Warltier DC. Levosimendan, a new positive inotropic drug, decreases myocardial infarct size via activation of K(ATP) channels. Anesth Analg 2000; 90: 5-11.
55. Moiseyev VS, Poder P, Andrejevs N, Ruda MY, Golikov AP, Lazebnik LB, et al. Safety and efficacy of a novel calcium sensitizer, levosimendan in patients with left ventricular failure due to an acute myocardial infarction: A randomized, placebo-controlled, double-blind study (RUSSLAN). Eur Heart J 2002; 23: 1422-32.
56. Delaney A, Bradford C, McCaffrey J, Bagshaw SM, Lee R. Levosimendan for the treatment of acute severe heart failure: A meta-analysis of randomised controlled trials. Int J Cardiol 2008; Sep 23 (Epub ahead of print)
57. Parissis JT, Paraskevaidis I, Bistola V, Farmakis D, Panou F, Kourea K, et al. Effects of levosimendan on right ventricular function in patients with advanced heart failure. Am J Cardiol 2006; 98: 1489-92.
58. Sonntag S, Sundberg S, Lehtonen LA, Kleber FX. The calcium sensitizer levosimendan improves the function of stunned myocardium after percutaneous transluminal coronary angioplasty in acute myocardial ischemia. J Am Coll Cardiol 2004; 43: 2177-82.
59. De Luca L, Proietti P, Celotto A, Bucciarelli-Ducci C, Benedetti G, Di Roma A, et al. Levosimendan improves hemodynamics and coronary flow reserve after percutaneous coronary intervention in patients with acute myocardial infarction and left ventricular dysfunction. Am Heart J 2005; 150: 563-8.
60. Garcia –Gonzalez MJ, Dominguez-Rodriguez A, Ferrer-Hita JJ, Abreu-Gonzalez P, Munoz MB. Cardiogenic shock after primary percutaneous coronary intervention: Effects of levosimendan compared with dobutamine on haemodynamics . Eur J Heart Fail 2006; 8: 723-8.
61. Çavuşoğlu Y, Beyaztaş A, Entok E, Birdane A, Ata N, Ünalır A, et al. Additive improvement of systolic and diastolic functions by the concomitant administration of levosimendan and dobutamine in left ventricular dysfunction: A radionuclide ventriculographic study. American Heart Asssociation Scientific Sessions 2006; November 12-15, 2006, Chicago, Illinois. Circulation 2006; 114 (Suppl.): 2946.
62. Nanas JN, Papazoglou PP, Terrovitis JV, Kanakakis J, Dalianis A, Tsolakis E, et al. Haemodynamic effects of levosimendan added to dobutamine in patients with decompensated advanced heart failure refractory to dobutamine alone. Am J Cardiol 2004; 94: 1329-32.
63. Delle Karth G, Buberl A, Geppert A, Neunteufl T, Huelsmann M, Kopp C, et al. Hemodynamic effects of a continuous infusion of levosimendan in critically ill patients with cardiogenic shock requiring catecholamines. Acta Anaesthesiol Scand 2003; 47: 1251-6.
64. Steg PG, Dabbous OH, Feldman LJ, Cohen-Solal A, Aumont MC, López-Sendón J, et al. Determinants and prognostic impact of heart failure complicating acute coronary syndromes: observations from the Global Registry of Acute Coronary Events (GRACE). Circulation 2004; 109: 494-9.
65. Torabi A, Cleland JGF, Khan NK, Loh PH, Clark AL, Alamgir F, et al. The timing of development and subsequent clinical course of heart failure after a myocardial infarction. Eur Heart J 2008; 29: 859-70.
66. Peacock WF 4th, De Marco T, Fonarow GC, Diercks D, Wynne J, Apple FS, et al. Cardiac troponin and outcome in acute heart failure. N Engl J Med 2008; 358: 2117-26.
67. Meine TJ, Roe MT, Chen AY, Patel MR, Washam JB, Ohman EM, et al. Association of intravenous morphine use and outcomes in acute coronary syndromes: results from the CRUSADE Quality Improvement Initiative. Am Heart J 2005; 149: 1043-9.
68. Rott D, Behar S, Leor J, Boyko V, Mandelzweig L, et al. Effect on survival of acute myocardial infarction in Killip classes II or III patients undergoing invasive coronary procedures. Am J Cardiol 2001; 88: 618-23.
69. Gheorghiade M, Abraham WT, Albert NM, Greenberg BH, O'Connor CM, She L, et al. Systolic blood pressure at admission, clinical characteristics, and outcomes in patients hospitalized with acute heart failure. JAMA 2006; 296: 2217-26.
70. Delle Karth G, Buberl A, Geppert A, Neunteufl T, Huelsmann M, Kopp C, et al. Haemodynamic effects of a continuous infusion of levosimendan in critically ill patients with cardiogenic shock requiring catecholamines. Acta Anaesthesiol Scand 2003; 47: 1251-6.
71. Lehmann A, Lang J, Boldt J, Isgro F, Kiessling AH. Levosimendan in patients with cardiogenic shock undergoing surgical revascularization: a case series. Med Sci Monit 2004; 10: 89-93.
72. Cohn JN, Franciosa JA, Francis GS, Archibald D, Tristani F, Fletcher R, et al. Effect of short-term infusion of sodium nitroprusside on mortality rate in acute myocardial infarction complicated by left ventricular failure: results of a Veterans Administration cooperative study. N Engl J Med 1982; 306: 1129-35.
73. Woods J, Monteiro P, Rhodes A. Right ventricular dysfunction. Curr Opin Crit Care 2007;13: 532-40.
74. Piazza G, Goldhaber SZ. The acutely decompensated right ventricle. Chest 2005; 128: 1836-52.
75. Parissis JT, Paraskevaidis I, Bistola V, Farmakis D, Panou F, Kourea K, et al . Effects of levosimendan on right ventricular function in patients with advanced heart failure.. Am J Cardiol 2006; 98: 1489-92.
76. Morelli A, Teboul JL, Maggiore SM, Vieillard-Baron A, Rocco M, Conti G, et al. Effects of levosimendan on right ventricular afterload in patients with acute respiratory distress syndrome: A pilot study. Crit Care Med 2006; 34: 2287-93.
77. Pinto BB, Rehberg S, Ertmer C, Westphal M. Role of levosimendan in sepsis and septic shock. Curr Opin Anesthesiol 2008;21:168-77.

APA	ZOKHİ M, Çavuşoğlu Y, YILMAZ M, Nalbantgil S, Eren M, MEBAZAA A (2009). Akut kalp yetersizliğine algoritmalarla pratik yaklaşım. , 436 - 446.
Chicago	ZOKHİ Mehdi,Çavuşoğlu Yüksel,YILMAZ MEHMET BIRHAN,Nalbantgil Sanem,Eren Mehmet,MEBAZAA Alexadre Akut kalp yetersizliğine algoritmalarla pratik yaklaşım. (2009): 436 - 446.
MLA	ZOKHİ Mehdi,Çavuşoğlu Yüksel,YILMAZ MEHMET BIRHAN,Nalbantgil Sanem,Eren Mehmet,MEBAZAA Alexadre Akut kalp yetersizliğine algoritmalarla pratik yaklaşım. , 2009, ss.436 - 446.
AMA	ZOKHİ M,Çavuşoğlu Y,YILMAZ M,Nalbantgil S,Eren M,MEBAZAA A Akut kalp yetersizliğine algoritmalarla pratik yaklaşım. . 2009; 436 - 446.
Vancouver	ZOKHİ M,Çavuşoğlu Y,YILMAZ M,Nalbantgil S,Eren M,MEBAZAA A Akut kalp yetersizliğine algoritmalarla pratik yaklaşım. . 2009; 436 - 446.
IEEE	ZOKHİ M,Çavuşoğlu Y,YILMAZ M,Nalbantgil S,Eren M,MEBAZAA A "Akut kalp yetersizliğine algoritmalarla pratik yaklaşım." , ss.436 - 446, 2009.
ISNAD	ZOKHİ, Mehdi vd. "Akut kalp yetersizliğine algoritmalarla pratik yaklaşım". (2009), 436-446.

APA	ZOKHİ M, Çavuşoğlu Y, YILMAZ M, Nalbantgil S, Eren M, MEBAZAA A (2009). Akut kalp yetersizliğine algoritmalarla pratik yaklaşım. Anadolu Kardiyoloji Dergisi, 9(6), 436 - 446.
Chicago	ZOKHİ Mehdi,Çavuşoğlu Yüksel,YILMAZ MEHMET BIRHAN,Nalbantgil Sanem,Eren Mehmet,MEBAZAA Alexadre Akut kalp yetersizliğine algoritmalarla pratik yaklaşım. Anadolu Kardiyoloji Dergisi 9, no.6 (2009): 436 - 446.
MLA	ZOKHİ Mehdi,Çavuşoğlu Yüksel,YILMAZ MEHMET BIRHAN,Nalbantgil Sanem,Eren Mehmet,MEBAZAA Alexadre Akut kalp yetersizliğine algoritmalarla pratik yaklaşım. Anadolu Kardiyoloji Dergisi, vol.9, no.6, 2009, ss.436 - 446.
AMA	ZOKHİ M,Çavuşoğlu Y,YILMAZ M,Nalbantgil S,Eren M,MEBAZAA A Akut kalp yetersizliğine algoritmalarla pratik yaklaşım. Anadolu Kardiyoloji Dergisi. 2009; 9(6): 436 - 446.
Vancouver	ZOKHİ M,Çavuşoğlu Y,YILMAZ M,Nalbantgil S,Eren M,MEBAZAA A Akut kalp yetersizliğine algoritmalarla pratik yaklaşım. Anadolu Kardiyoloji Dergisi. 2009; 9(6): 436 - 446.
IEEE	ZOKHİ M,Çavuşoğlu Y,YILMAZ M,Nalbantgil S,Eren M,MEBAZAA A "Akut kalp yetersizliğine algoritmalarla pratik yaklaşım." Anadolu Kardiyoloji Dergisi, 9, ss.436 - 446, 2009.
ISNAD	ZOKHİ, Mehdi vd. "Akut kalp yetersizliğine algoritmalarla pratik yaklaşım". Anadolu Kardiyoloji Dergisi 9/6 (2009), 436-446.