CHF-lecture药理课件.ppt

Treatment of congestive heart failure Overview of congestive heart failure Congestive heart failure (CHF) is a condition in which the heart is unable to pump sufficient blood to meet the needs of body. CHF can be increased workload imposed on the heart. CHF is accompanied by abnormal increases in blood volume and interstitial fluid; the heart, veins, and capillaries are therefore generally dilated with blood. Hence the term “congestive(充血性)” heart failure, since the symptoms include pulmonary congestion with life heart failure, and peripheral edema with right heart failure. Underlying causes of CHF include arteriosclerotic heart disease, hypertensive heart disease, valvular heart disease(心瓣膜病), dilated cardiomyopathy(扩张性心肌病), and congenital heart disease(先天性心脏病). Left systolic dysfunction secondary to coronaryartery disease is the most common cause of heart failure. Heart Failure Final common pathway for many cardiovascular diseases whose natural history results in symptomatic or asymptomatic left ventricular dysfunction Cardinal manifestations of heart failure include dyspnea, fatigue and fluid retention Risk of death is 5-10% annually in patients with mild symptoms and increases to as high as 30-40% annually in patients with advanced disease Main causes Coronary artery disease Hypertension Valvular heart disease (心瓣膜病) Cardiomyopathy (心肌病) Cor pulmonale Compensatory changes in heart failure Activation of SNS Activation of RAS Increased heart rate Release of ADH Release of atrial natriuretic peptide心钠素 Chamber enlargement 心室腔扩大 Myocardial hypertrophy 心室肥厚 Classification of heart failure Class I: No limitation of physical activity Class II: Slight limitation of physical activity Class III: Marked limitation of physical activity Class IV: Unable to carry out physical activity without discomfort New classification of heart failure Stage A: Asymptomatic with no heart damage but have risk factors for heart failure Stage B: Asymptomatic but have signs of structural h