右心衰竭的诊断与治疗.pptVIP

右心室解剖、功能特点 * * * * * * * * * * * * Figure 2. Masson trichrome stain showing extensive RV ?brosis in SuHx (C) but not in PAB (B) or controls (A). Fibrotic areas are distributed randomly across the RV free walls. G, Fibrosis quanti?cation (blue-stained areas expressed as percent age of total RV surface area) of digitized images. Staining with malondialdehyde antibodies shows evidence of oxidative stress in the SuHx RV but not PAB RV (D through F and H). Figure 4. Confocal images of lectin stained RV microvessels (in vivo perfusion with tomato lectin stains red; DAPI staining of nuclei is blue). Capillaries in the SuHx model (C) are less abundant and are morphologically heterogeneous, whereas capillaries in PAB (B) resemble those in controls (A). Capillary volume (expressed as percent- age of tissue volume) is signi?cantly decreased in SuHx vs controls and PAB (G). E, F, and H. A similar decrease in capillary density as assessed by anti- CD31 staining. * 干预潜在危险因素或疾病 密切检测右室功能 家族遗传病基因筛查 戒酒 戒违禁药物 规律锻炼 有心脏结构变化或右心功能不全 无右心衰症状 如：肺动脉高压 先心病 左心衰竭或瓣膜病 心肌病或ARVD 无症状瓣膜病（三尖瓣、肺动脉瓣） RVMI病史 对应于左心衰分期的“前临床心衰阶段”(pre-clinical heart failure) A期所有措施 适当选用ACEI/ARB、β受体阻滞剂 华发林：右心血栓、房扑/房颤、慢性栓 塞性肺动脉高压、肺动脉高压 先心病、瓣膜病、肺动脉高压选择适当病人行外科手术或介入治疗 必要时植入ICD 出现右心衰症状 器质性心脏病或右心功能不全合并以下情况： 体液潴留、疲劳、运动耐量下降、心悸 对应于左心衰分期的“临床心衰期” A期和B期所有措施 利尿剂+/-地高辛 所有适用于B期的药物 先心病、瓣膜病、肺动脉高压：选择适当病人行外科手术或介入治疗 必要时植入起搏器CRT-D或或消融电复律 难治性心衰期 需特殊干预治疗 接受了充分药物治疗、介入治疗或外科手术，静息状态下仍有明显症状 顽固性、难治性心律失常 对应于左心衰分期的“难治性心衰阶段” A、B、C期所有措施 肺动脉高压必要时行房间隔造瘘术 心脏移植（无PH）、肺移植或心肺移植（有PH） 持续非洋地黄正性肌力药物 心脏辅助装置 实验性药物或手术 临终关怀 * 谢 谢！ * * RVEF may be useful as both a marker and mechanism of poor prog