心力衰竭的内科与介入治疗.pdfVIP

心力衰竭的内科与介入治疗 浙江大学医学院附属第一医院 陶谦民 定义 • 心力衰竭是心脏各种疾病发展到中、末期导致心 脏功能障碍，出现心功能不全（cardiac insufficiency）的一组临床综合征，多指临床出 现心肌收缩力下降使心排血量不能满足机体代谢 的需求，器官、组织血液灌注不足，同时出现肺 循环和/或体循环淤血的表现。 HF Incidence and Prevalence • Prevalence – Worldwide, 22 million1 – United States, 5 million2 • Incidence – Worldwide, 2 million new cases annually1 – United States, 500,000 new cases annually2 • Heart failure affects 5.7 million people in the United States, accounting for approximately 1 3 million admissions and 1 in 9 deaths annually . HF afflicts 10 out of every 1,000 over age 65 in the U.S.2 1 World Health Statistics, World Health Organization, 1995. 2 American Heart Association, 2002 Heart and Stroke Statistical Update. 3 Circulation. 2010;122(19):1975- 1996 Left Ventricular Dysfunction • Systolic: Impaired contractility/ejection – Approximately two-thirds of heart failure patients have systolic dysfunction1 • Diastolic: Impaired filling/relaxation 30% (EF 40 %) (EF 40%) 70% Diastolic Dysfunction Systolic Dysfunction 1 Lilly, L. Pathophysiology of Heart Disease. Second Edition p 200 General Measures Medical Considerations: Lifestyle Modifications: • Treat HTN, hyperlipidemia, diabetes, • Weight reduction arrhythmias • Coronary • Discontinue revascula