心衰的代偿机制.pptVIP

Compensatory Mechanisms to Heart Failure 王刚 张萨丽 陶萄 罗碧芬 Compensatory Mechanisms to HF A.Neurohumoral Activation A.Neurohumoral Activation A.Neurohumoral Activation B.Functional Adjustment B.Functional Adjustment C. Structural Adaptation C. Structural Adaptation C. Structural Adaptation C. Structural Adaptation C. Structural Adaptation C. Structural Adaptation C. Structural Adaptation D. Extracardial Compensation Compensatory Mechanisms to HF 病例分析 LOGO 病例1 Neurohumoral Activation Functional Adjustment Heart Failure A B Extracardial Compensation D Structural Adaptation C 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 (+) RAAS Sympathetic Nervous System NA Ang II HF long-term β-R desensitize NA reduction Venous return Vessel construction Preload Afterload Renin ANF BNP HF Rasodilatation H2O Na+ Ald ADH Resistance vessel construction of SNS （-） （-） （-） 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+ Increased Heart Rate Increased Preload Increased Contractility oxygen-consumption coronary artery perfusion { L3.6μm contractibility 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 Concentric Hypertrophy Eccentric Hypertrophy Myocardial Hypertrophy Myocardial cell thickening Ventricular wall thickening Volume of chambers normal Length of Myocardial cell increases Ventricular wall thickening Volume of chambers increase 1 Myocyte remodeling Myocardial Hypertrophy Contractility CO sustaining Tension of ventricular wall oxygen consumption Hypoxia Disorder of energy metabol