血液循环障碍PATHOPHYSIOLOGY OF HEART FAILURE.pptVIP

PATHOPHYSIOLOGY OF HEART FAILURE Jianzhong Sheng MD PhD Definition of diastolic heart failure It is pathophysiological process characterized by symptoms and signs of congestive heart failure, which is caused by increased filling resistance of ventricles and increased intraventricular diastolic pressure Primary diastolic heart failure no signs and symptoms of systolic dysfunction is present - ! up to 40% of patients suffering from heart failure! Secondary diastolic heart failure - diastolic dysfunction is the consequence of primary systolic dysfunction * Notes to heart physiology Essential functions of the heart to cover metabolic needs of body tissue (oxygen, substrates) by adequate blood supply to receive all blood coming back from the tissue to the heart Essential conditions for fulfilling these functions normal structure and functions of the heart adequate filling of the heart by blood Essential functions of the heart are secured by integration of electrical and mechanical functions of the heart Cardiac output (CO) = heart rate (HR) x stroke vol.(SV) - changes of the heart rate - changes of stroke volume Control of HR: - autonomic nervous system - hormonal(humoral) control Control of SV: - preload - contractility - afterload Adaptive mechanisms of the heart to increased load ? Frank - Starling mechanism ? Ventricular hypertrophy – increased mass of contractile elements ? ?strength of contraction ? Increased sympathetic adrenergic activity – increased HR, increased contractility ? Incresed activity of R–A–A system Causes leading to changes of number and size of cardiomyocytes Preload Stretching the myocardial fibers during diastole by increasing end-diastolic volume ? ?force of contraction during systole = Starling′s law preload = diastolic muscle sarcomere length leading to increased tension in muscle before its contraction (Fig. 2,3) venous return to