内科学心力衰竭范维琥.ppt

Heart failure DEFINITION HEART FAILURE A clinical syndrome in which an abnormality of cardiac structure or function is responsible for the inability of the heart to eject or fill with blood at a rate commensurate with the requirements of the metabolizing tissues. Heart failure results in a constellation of clinical manifestations, including circulatory congestion, dyspnea, fatigue, and weakness. FORMS OF HEART FAILURE Systolic vs diastolic heart failure Low-output vs high-output heart failure Acute vs chronic heart failure Right-sided vs left-sided heart failure UNDERLYING CAUSES Ischemic heart disease Cardiomyopathies Congenital, valvular and hypertensive heart disease (potential treatable ) PRECIPITATING FACTORS Infection Arrhythmias Physical, dietary, fluid, environmental, and emotional excesses Myocardial infarction Pulmonary embolism Anemia Thyrotoxicosis and pregnancy Aggravation of hypertension Rheumatic, viral, and other forms of myocarditis Infective endocarditis PATHOGENESIS Chronic hemodynamic overload→eccentric ventricular hypertrophy Chronic pressure overload → concentric ventricular hypertrophy Ventr. hypertrophy → ventr. Dilatation Remodeling of ventricle → HF Activation of endogenous neurohormonal system and cytokines CLINICAL MANIFESTATION OF HF Primary Symptoms Dyspnea Orthopnea Paroxysmal (nocturnal) dyspnea Acute pumnonary edema CLINICAL MANIFESTATION OF HF Other symptoms Fatigue and weakness Abdominal symptoms Cerebral symptoms PHYSICAL FINDINGS OF HF General findings ↓Pulse pressure （severe HF) ↓ SBP with cool, diaphoretic extremities, and Cheyne -Stokes respiration Cyanosis, sinus tachycardia PHYSICAL FINDINGS OF HF Cardiovascular findings S3 and S4 Cardiomegaly Murmurs Pulsus alternans Distention of j v. (↑systemic v. p) PHYSICAL FINDINGS OF HF Pulmonary rales Cardiac edema Symmetric and dependent in the legs Most prominet in evening Hydrothorax and ascites Congestive hepatomegaly. LABORATORY EXAMINAT