【临床医学】范维琥－心力衰竭.pptVIP

Heart failure DEFINITION HEART FAILURE the pathophysiological state in which the heart is unable to pump blood at a rate commensurate with the requirement of the metabolizing tissues or can do so only from an elevated filling pressure. Usually caused by a defect in myocardial contraction (myocardial failure). DEFINITION CONGESTIVE HEART FAILURE Clinical manifested as Pulmonary congestion Systemic congestion Inadequate tissure blood perfusion HEMODYNAMICALLY heart failure (cardiac dysfunction) is diagnosed when LVEDP18mmHg or RVEDP10mmHg UNDERLYING CAUSES Primary myocardial dysfunction (systolic and/or diastolic) Cardiomyopathy Primary or secondary metabolic disturbances of myocardium Overloading of heart Pressure overloading Volume overloading limited diastolic function UNDERLYING CAUSES Age 70.3±10.1 yr. Causes CHD 65.8% Hypertension 36.0% Dila. Cardiomy. 11.9% With 2°DM 14.9% Shanghai OPD, Chin J Cardiol 2001;29:644 Precipitating factors infection arrhythmias Pulmonary embolism overfatigue Pregnancy and delivery Anemia and hemorrhage others Pathophysiology Frank-Starling mechanism Activation of neurohormonal pathway (SAS and RAS) Myocardial damage and remodeling Diasatolic heart failure CLINICAL CLASSIFICATION A cute vs. chronic heart failure Right-sided vs. left-sided Heart failure Low-output vs high-output heart failure Systolic vs diastolic heart failure Asymptomatic vs congestive heart failure Chronic left-sided HF ：symptoms Respiratory distress Exertional dyspnea Paroxysmal nocturnal dyspnea Orthopnea Acute pumnonary edema Cough (nonproductive), and hemoptysis Reduced exercise capacity Fatigue and weakness Urinary symptoms Chron. left-sided HF ：Physi. findings General appearance Dyspnetic Cyanosis, icterus, malar flush, diminished pulse pressure, reduced SBP, rapid, weak and thready p