18.heartfailure.pptVIP

Cardiac insufficiency Introduction What is the normal cardiac structure and function? Structure Function pumping blood endocrine Process of pumping blood excitation contration pumping blood Cardiac output (CO, minute volume): stroke volume × heart rate Stroke volume: end-diastolic volume (145ml) - end-systolic volume (75ml) Factors of effecting cardiac output: preload, afterload, myocardial contractility, heart rate Concept Cardiac insufficiency： causes pump function Heart failure： 在各种致病因素作用下，心脏的收缩和(或)舒张功能发生障碍，使CO绝对或相对下降，以至不能满足机体代谢需要的病理过程。 Congestive heart failure： Myocardial failure： What is the causes and precipitating factors of heart failure？ Ⅰ The cause,precipitating factor and classification of heart failure Ⅰ) Etiology 1. cardiac muscles was injured: ① mycardiopathy: myocardial infarction, myocarditis etc. ② cardiac muscle’s metabolism was disturbanced : ischemia，hypoxia , deficit of vitamin B1 . ▲primary myocardial contractility /diastolic function 2. ventricular load was overweight ① afterload : BP , valvular stenosis ② preload : valvular regurgitation, high dynamic circulation ▲ secondary myocardial contractility /diastolic function 3. ventricular fill balk 4. arrhythmia Ⅱ) predisposing factors 1. general infection ① metabolic rate ② endotoxin ③ heart rate ④ infection of respiratory system 2. disorders of acid-base and electrolyte ① acidosis ② hyperkalemia 3. arrhythmia 4. pregnancy and delivery Cases Case1 患者,女性,36岁。 主诉：因发热、呼吸急促及心悸3周入院。 现病史：4年前病人开始于劳动时自觉心慌气 短，近半年来症状加重，同时下肢出现浮肿。1 个月前，经常被迫采取端坐位并时常于晚间睡 眠时惊醒，气喘不止，经急诊抢救好转。 近三周来，出现恶寒发热，咳嗽，痰中时有 血丝，心悸气短加重。 既往史：患者于儿童时期曾因患咽喉肿痛而 做扁桃