成果儿保留学生实习chd.pptxVIP

;Objective;Part one: Case Discussion;Physical examination: body weight: 10Kg, no cyanosis; chest abdominal breathing, three depressions sign, crackles in the lungs; protrusion of precordium, Ⅳ/6 grade pansystolic murmur in the third and fourth left intercostal spaces, palpable thrill, accentuation of P2; liver enlarged with its lower edge 2cm below the right costal margin. ;Assistant examination: Chest X-ray: increased lung markings, cardiac enlargement, C/T(cardiothoracic ratio): 0.56 Electrocardiogram (ECG): high left ventricular voltage（left ventricular hypertrophy） Ultrasonic Cardiogram (UCG): ventricular septal defect, pulmonary hypertension ;Clues of Diagnosis;Diagnosis;Principles of Treatment;Principles of Treatment;Part two: Heart Failure;CLINICAL MANIFESTATIONS;CLINICAL MANIFESTATIONS;Chest X-ray;Electrocardiogram (ECG);Echocardiogram ;Treatment;2、Diet： eat more frequently but smaller meals light diet but nutritious food nasogastric feeding when nesessary ;3、Fluid restriction： totle intravenous fluid volume: 75ml/kg/day maintain water, electrolyte and acid-base balance;Treatment;Treatment;Treatment;Treatment;Treatment;Treatment;Treatment;Captopril (Capoten): 0.5~1.0mg/kg/time, bid or tid, po Enalapril (Vasotec): 0.08~0.1mg/kg/day, qd , po Benazapril: 0.1mg/kg/day, qd, po, a week later, increased to 0.3~0.4mg/kg/day gradually ;ACEI should be used with caution in: （1）bilateral renal artery stenosis （2）significantly high serum creatinine (225.2μmol/L) （3）hyperkalemia (5mmol/L) （4）hypotension ;Treatment;9、α- and β-Adrenergic Agonists Used in patients refractory to digitalis or having digitalis contraindications Dopamine, Dobutamine, Isoproterenol, Epinephrine dose should be carefully titrated to hemodynamic response ;Treatment;The end