Update in Heart Failure DartmouthHitchcock更新心力衰竭达特茅斯希区柯克.pptVIP

Heart Failure: Living with a Hurting Heart James T. DeVries, MD Dartmouth-Hitchcock Medical Center Outline Definitions and scope of problem Diagnosing and classifying heart failure Approach to management of CHF Oral drug therapy (ACE-I, ARB, betablockers, aldosterone blockade, digoxin) Device therapy Biventricular (BiV) pacers Intracardiac defibrillators (ICD’s) Future directions and exciting developments Congestive Heart Failure Heart (or cardiac) failure is the state in which the heart is unable to pump blood at a rate commensurate with the requirements of the tissues or can do so only from high pressures Congestive Heart Failure Symptoms: Shortness of breath Leg swelling (edema) Breathing worsens with lying flat (orthopnea) Fatigue Anatomy 101 Types of Heart Failure Systolic (or squeezing) heart failure Decreased pumping function of the heart, which results in fluid back up in the lungs and heart failure Diastolic (or relaxation) heart failure Involves a thickened and stiff heart muscle As a result, the heart does not fill with blood properly This results in fluid backup in the lungs and heart failure Risk Factors for Heart Failure Coronary artery disease Hypertension (LVH) Valvular heart disease Alcoholism Infection (viral) Diabetes Congenital heart defects Other: Obesity Age Smoking High or low hematocrit level Obstructive Sleep Apnea Epidemiology of Heart Failure in the US More deaths from heart failure than from all forms of cancer combined 550,000 new cases/year 4.7 million symptomatic patients; estimated 10 million in 2037 “Wow! Brazil is big. —George W. Bush, after being shown a map of Brazil by Brazilian president Luiz Inacio Lula da Silva, Brasilia, Brazil, Nov. 6, 2005 Classifying Heart Failure:Terminology and Staging A Key Indicator for Diagnosing Heart Failure Ejection Fraction (EF) Ejection Fraction (EF) is the percentage of blood that is pumped out of your heart during each beat Classification of HF: Comparison Between ACC/AHA HF Stag