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Heart Failure 上海交通大学医学院 附属仁济医院心内科 张 清 副教授 Heart failure is the pathophysiological state in which the heart is unable to pump sufficient blood to satisfy the metabolic demands of the body with enough preload. The Progressive Development of Cardiovascular Disease For progressive duration Congestive heart failure is classified into acute and chronic heart failure Congestive heart failure is classified into left side, right side and biventricular heart failure Chronic heart failure Causes Fundamental causes: impairment of myocardium, such as AMI,cardiomyopathy,myocarditis overloading of the heart, such as hypertension, aortic stenosis, mitral stenosis,emphysema,aortic insufficiency,mitral insufficiency,VSD,PDA,ASD. diminished LV compliance, such as ventricular hypertrophy Pathophysiology of heart failure Impaired myocardium ↓ Cardiac output ↓, heart failure ↓ Neurohumoral stimulation RAS and sympathetic-adrenergic↑ ↓ ↓ Vasoconstriction increased heart rate Salt and water retention increased energy (augments preload) expenditure Hypertrophy ↓ Leads to deterioration and death of cardiac cell Effects of Neurohormonal Stimulation in Heart Failure Heart Heart rate Contractility Stroke volume Cardiac output Conduction velocity Myocardial oxygen consumption Peripheral Circulation Arterial vasoconstriction Venoconstriction Systemic vascular resistance Redistribution of blood flow Renal vasoconstriction Pathophysiology of Heart Failure: Left Ventricular Remodeling Left-ventricular (LV) remodeling is defined as a change in LV geometry, mass and volume that occurs over a period of time Ventricular Remodeling: Compensatory Mechanism Dilation Hypertrophy Globular shape Short term: Compensatory Long term: Harmful Vicious Cycle of Heart Failure Pathophysiology and Therapeutic A