Heart Failure(中国医大7年制《内科学》课件).ppt

Heart Failure Xiaojuan Bai Heart failure is an imprecise term used to describe the state that develops when the heart cannot maintain an adequate cardiac output or can do so only at the expense of an elevated filling pressure. Pathophysiology 1. Frank-Starling’s Law of the heart a. The cardiac output is a function of the preload, the afterload, and myocardial contractility. b.Preload: the volume and pressure of blood in the ventricle at the end of diastole. c. Afterload :the arterial resistance. Type of heart failure Heart failure can be described or classified in several ways. 1.?Acute and chronic heart failure 2.?Left ,right and biventricular heart failure 3.?High and low output heart failure 4.?Diastolic and systolic dysfunction 5.Asymptomatic and congestive heart failure 3.biventricular heart failure  have clinical manifestation of left and right heart failure. Conditions with normal systolic function and decreased diastolic function include: (1) systemic arterial hypertension (2) myocarditis (3) hyretrophic cardiomyopathy (4) congestive cardiomyopathy In the setting of left ventricular dysfunction, which of following neurohormonal factors would be activated? (1)Norepinephrine (2)Endothelin (3)Arginie vasopreein (4)Endothelial-derived relaxing factor Investigation 1.routine examination blood, urine, renal function, electrolyte, liver function 2.ECG a.no specific findings . b.Abnormalities may provide etiological clue(ventricular hypertrophy,AMI,bundle branch block) c.V1ptf-0.03mm/s left atrial overload 3.Echocardiography:evaluating LV as well as other chamber dimensions, ejection fraction, and wall motion abnormality. a.M:obtained directing a stationary ultrasonography beam at some portion of the heart. b.Two-dimensional Echo (2-DE):provides spatially correct ima