课件：心力衰竭的诊断和治疗.ppt

心 衰 罗伯特·图尔斯，全球第一位全内置式人工心脏移植患者在移植手术后近5个月于2001年11月30日（美国当地时间）在美国肯塔基州路易斯维尔大学附属的犹太医院去世，享年59岁。 人工心脏 人工心脏（Abiocor） 心 衰 心脏再同步化治疗 患者选择 宽 QRS*波 EF 35%* NYHA III-IV* 窦性心律，完全性左束支阻滞 (具体见2013年中国心衰指南) *Representative of criteria used in referenced studies 心脏再同步治疗增加了心脏的工作效率 双心室起搏电极放置位置 右房电极 右室电极 冠状窦电极 心脏再同步化治疗 经静脉双心室起搏电极 心电图QRS波宽度下降 -------Therapy OFF------- ---------Therapy ON------------- QRS=160 ms QRS=120 ms Lead V3 心衰治疗的展望 心肌重构—ACEI 、β— blocker二酯酰酸甘油修饰剂蛋白激酶C3抑制剂 心衰时分子生物学治疗手段基因治疗干细胞治疗 心衰整体治疗 运动训练和康复 多学科管理 姑息治疗 THANK YOU SUCCESS * * 可编辑 对HF认识的逐渐演变也导致了不同时期心衰治疗原则及药物的变化 OPTIME-HF试验已经证明米力农可提高心衰患者的远期死亡率，临床限制使用。 Let’s compare our heart to this donkey, and our body to the wagon that this donkey has to pull every day. A healthy heart is like an energetic donkey, which without fatigue, pulls the wagon full of weights. Conversely, a diseased heart will have difficulty meeting metabolic demands (or pulling the wagon). Angiotensin II is the central molecule of the RAS, with a multitude of actions. Both the antihypertensive and the protective effects of RAS modulators are related to their influence on angiotensin II actions. ACE inhibitors block the conversion of angiotensin I to angiotensin II and also have other substrates including bradykinin, substance P, neurotensin, enkephalin, LHRH, N-acetyl-Ser-Asp-Lys-Pro. The effects on kinins is suggested to be responsible for the cough associated with ACE inhibitors. ACE inhibitors do not block the conversion of Ang I to Ang II by alternative enzymes prominent in heart tissue, such as chymase. Ang II receptor blockers such as valsartan block the action of Ang II directly at its receptor, regardless of synthesis pathway. In heart failure, angiotensin II activity may play a pathological role. The deleterious effects of angiotensin II are mediated via the AT1 receptor subtype. There is also accumulating evidence that many of the more beneficial actions of angiotensin II are mediated via the AT2 receptor. Therefore selec