(精选)【医学课件】心衰的代偿机制教学课件.pptVIP

LOGO Compensatory Mechanisms to Heart Failure 王刚 张萨丽 陶萄 罗碧芬 病例1 Compensatory Mechanisms to HF Neurohumoral Activation Functional Adjustment Heart Failure A B Extracardial Compensation D Structural Adaptation C A.Neurohumoral Activation RAAS Sympathetic Nervous System NA HR CO Resistance vessel construction Perfusion pressure β-R α-R Ang II (+) Ald ADH Vessel construction H2O Na+ retention Venous return CO HF (+) A.Neurohumoral Activation RAAS Sympathetic Nervous System NA Ang II HF long-term β-R desensitize NA reduction Venous return Vessel construction Preload Afterload Renin A.Neurohumoral Activation ANF BNP HF Rasodilatation H2O Na+ Ald ADH Resistance vessel construction of SNS （-） （-） （-） B.Functional Adjustment Increased Heart Rate Increased Preload Increased Contractility Cardiac Output CO BP Cerebral vessels coronary artery perfusion Frank-Starling Law Lmax =2.2μm NA β-R cAMP PKA Ca2+ channel protein phosphorylation Cytoplasm Ca2+ B.Functional Adjustment Increased Heart Rate Increased Preload Increased Contractility oxygen-consumption coronary artery perfusion { L3.6μm contractibility C. Structural Adaptation 心肌 重塑 Myocardial remodeling 由于心肌细胞、非心肌细胞及细胞外基质在基因表达改变的基础上所发生的变化，使心脏的结构、代谢和功能经历的模式重塑的过程 C. Structural Adaptation Non-Myocyte 2 Changes in Non-Myocyte Collagen I Collagen III C. Structural Adaptation fibroblast mechanical load chemical signal fibroblast Be able to Proliferate secrete Collagen Component of ECM Interstitial collagenaseGelatinase 胶原网络 synthesis degradation Biochemical remodeling Structural remodeling C. Structural Adaptation 胶原重塑 Collagen III 弹簧样螺旋结构的侧向链接，伸展性和回弹性好 Collagen I 心肌束之间平行排列，提高抗张强度，防止应力过高时心肌细胞侧向滑动造成心室壁变薄和心腔扩大 重塑早期 Collagen III 增加明显 重塑晚期 Collagen I 增加明显 D. Extracardial Compensation Increas Ability of Cells to Use Oxygen Increase in Red Cells Redistribution of