心力衰竭知识教学教材.ppt

心力衰竭知识 The Causes of Heart Failure  The characterizations of CHF Decrease in cardiac contractility, inadequate cardiac output. Intravascular volume expansion and ventricular filling pressures↑, systemic and pulmonary hypertentension, dyspnea呼吸困难. Activation of sympathetic nervous and RAS Myocardial dysfunction. Ventricular remodeling. Ventricular remodeling after acute infarction Ventricular remodeling in diastolic舒张 and systolic收缩 heart failure Initial infarct Expansion of infarct (hours to days) Global remodeling (days to months) Normal heart Hypertrophied heart (diastolic heart failure) Dilated heart (systolic heart failure) Myocardial remodeling in Calcineurin transgenic hearts (Cell, Vol 93, 215-228,1998) Heart failure Reduced cardiac output Sympathetic nervous system activation Vasoconstriction Elevated cardiac filling pressure Sodium and water retention Angiotensin Ⅰ Renin Cardiac remodeling Aldosterone AngiotensinⅡ Pathophysiological mechanisms of heart failure and major sites of drug action digoxin β -blockers, digoxin Vasodilators ACE inhibitors Diuretics Spironolactone Classification of drugs used in CHF 1. Renin-angiotensin-aldosterone system inhibitors (1) ACEI captopril (2) angⅡ receptor blocker (AT1 antagonist) losartan (3) aldosterone antagonist spironolacton 2. Diuretics thiazides, furosemide 3. -receptor blocker Metoprolol, carvedilol 4. positive inotropic agents (1)Cardiac glycosides digoxin, digitoxin (2)non-glycoside positive inotropic agents milrinone 5.vasodilators nitroprusside sodium 6.calcium sensitizer and calcium channel blockers amlodipine Section IIInhibitors of renin-angiotensin-aldosterone system (RAAS) Renin-Angiotensin System (RAS) angiotensinogen renin AngiotensinⅠ 糜酶旁路 ACE Angiotensin Ⅱ AT1receptor 1.  vasoconstriction, aldosterone↑：BP↑ 2.  hypertrophy and proliferation cardiovascular remodeling Kallikrein-Kinin System (KKS)  kininogenase Bradykinin 降解产物 AT2receptor NO ↑, part fight AT1receptor Vasodila