慢性心力衰竭ChronicHeartFailure(双语).ppt

Chronic Heart Failure   Peoples Hospital 心衰的分类 Types of Heart Failure Classification in terms of location Left ,right and biventricular heart failure Classification in terms of velocity Acute and chronic heart failure Classification in terms of mechanism Systolic or diastolic heart failure Clinical manifestation(left heart failure ) 左心衰竭：主要为肺循环淤血及心排血量降低为主要表现的。 Left heart failure：mainly manifested with pulmonary congestion and reduction of cardiac output Clinical manifestation (left heart failure ) 不同程度的呼吸困难 ①劳累性呼吸困难dyspnea on exertion（最早出现的症状the first a symptom） ②端坐呼吸orthopnoea ③夜间阵发性呼吸困难paroxysmal nocturnal dyspnea:often with wheeze sound in both lung【心源性哮喘cardiogenic asthma】 ④急性肺水肿acute pulmonary edema Clinical manifestation (left heart failure ) 咳嗽、咳痰、咯血Cough, expectoration, hemoptysis 乏力、疲倦、头昏、心慌 Weakness, fatigue on exertion, dizziness, flustered 少尿及肾功能损害Symptoms of oliguria and impaired renal function 早期为夜尿增多 in early period ,nocturia increase 后期为少尿in later period, oliguria Clinical manifestation(left heart failure ) Sing 肺部湿性罗音moist rales in the base of lung 心脏体征diffuse and laterally displaced apical impulse； gallop in early diastolic period , accentuated p2 ；systolic murmur at cardiac apex；pulses alternans occur when left ventricular ejective impedance increase Clinical manifestation (Right heart failure ) Symptom 消化道症状 ：食欲不振、腹胀、恶心、呕吐 Gastrointestinal tract symptom: anorexia, istention ,nausea 劳累性呼吸困难 dyspnea on exertion Clinical manifestation (Right heart failure ) Sign 水肿edema：is typical sign of right heart failure. at first occur in foot, ankle , anterior tibia. 颈静脉征cervical filling ，hepatic cervical reflux 肝肿大liver large，congestive liver 心脏体征 全心衰竭Biventricular heart failure 右心衰竭继发于左心衰竭形成全心衰竭，当右心衰竭出现后,左心衰竭肺淤血症状反而减轻，主要表现为心排血量减少的相关症状和体征。 have clinical manifestation of left and right heart failure Laboratory investigation 1.利钠肽 BNP,NT-proBNP BNP levels vary directly with severity Dyspnea