《儿科学》Heart Failure.pptVIP

Definition of Heart Failure Heart failure is a pathophysiological state of heart in which, the heart cannot pump enough blood to meet the needs required by the metabolizing tissue, or to do so only from an elevated filling pressure. Classification Etiological Causes of Heart Failure Myocardial damage: myocardial ischemia, inflammation etc. Increased cardiac load Increased preload: congenital heart diseases with left to right shunt. Increased afterload: hypertension, stenosis of cardiac valves. Disturbance of the diastolic filling: constrictive pericarditis, hypertrophic cardiomyopathy, etc. Pathophysiology Compensation ? Decompensation Adaptive mechanisms: Frank-Starling mechanism: Decreased cardiac ejection fraction ? increased ventricular end diastolic volume and pressure (LVEDP) ? elongation of the myocardial fiber ? increased contractility of the myocardium ? restoration of the ejection fraction Adjustment of neuro-endocrine systems Sympathetic activation Increased contractility of the myocardium Elevation of norepinephrine blood level Down regulation of ?1 receptor Activation of RAAS Others 神经内分泌系统的调节机制 交感神经系统、肾素-血管紧张素-醛固酮系统（RAAS）的激活:早期心输出量减少---兴奋交感神经---血中儿茶酚胺水平升高---早期代偿---心输出量增加。如果病因未消除，持续过度代偿，RAAS激活---心肌代谢增加、耗氧增加，β受体密度下调，心肌收缩力减弱，外周血管收缩，水钠潴留，心肌毒性等---促进心衰恶化，心室重构。 内分泌系统其他方面 Clinical Manifestation Three aspects: 1.general manifestation 2. manifestation of Left heart failure: polypnea dyspnea , signs of pulmonary congestion etc. 3. manifestation of right heart failure :general edema, enlargement of liver, distention of jugular vein, anorexia due to congestion of stomach pleural effusion, etc. Auxiliary Examination 1.Chest radiography: large cardiac sihouette, pulmonary venous congestion, edema 2. Echocardiography: cardiomegaly, ventricular disfunction, heart function↓(EF＜50％、FS＜30％、STI↑；IVRT ↑、 E/A ＜1) ，ect. 3. Electrocardiogram: Diagnosis of Heart Failure Clinical Findings: 1.HR↑ 2. Dyspnea, R↑ 3. Liver Enlargement 4. Cardiac