没有标题浙江大学教学信息化平台.pptxVIP

没有标题浙江大学教学信息化平台第1页/共48页ContentsHeart (cardiac) failure is said to have occurred when the heart is no longer able to maintain the circulation to the tissues for normal metabolism. Overview ACE inhibitors Diuretics ? receptor blockers Cardiac glycoside Others第2页/共48页A. Overview1. Pathophysiological changes of congestive heart failure (CHF)(1) Function and structure changes(2) Increased sympathetic activity and down-regulation of ? receptor(3) Activated renin-angiotensin-aldosterone system (RAAS)第3页/共48页第4页/共48页Pathophysiological changes of CHF第5页/共48页Pathophysiological changes of CHF第6页/共48页Cardiac failureCardiac outputBlood supplyVenous pressureRenal blood flowRenin - angiotension ⅡVenous hyperemiaAldosterone Pulmonary circulation:cough, emptysis, dyspneaSystemic circulation hyperemia :jugular vein distension, edemaSodium and waterretentionChanges in hemodynamics of CHF第7页/共48页A. Overview2. Grades of CHF Ⅰ(A): no symptoms Ⅱ(B): physical activities were limited and symptoms could be induced by general activity Ⅲ(C): physical activities were markedly limited Ⅳ(D): symptoms appear even at rest第8页/共48页A. Overview3. Therapeutic strategies in CHF(1) Increasing contractility of the cardiac muscles(2) Inhibiting RAAS (3) Reducing sympathetic activity (4) Dilating vessels(5) Diuresis ? Cardiacremodeling Decreaseoverload 第9页/共48页Drug therapy for CHF第10页/共48页B. Angiotensin converting enzyme inhibitors (ACEI) and angiotensin receptor antagonistsACEI: captopril 卡托普利 enalapril 依那普利AT1 receptor antagonists: losartan 氯沙坦 irbesartan 伊白沙坦第11页/共48页Systemic and localvasodilatationCardiovascular remodeling第12页/共48页B. Angiotensin converting enzyme inhibitors (ACEI) and angiotensin receptor antagonistsACEI1. Pharmacological effectsInhibiting the production of Ang II vasoconstriction ?; sodium retention ?; cardiac remodeling (myocardial hypertrophy) ?Inhibiting the degradation of bradykinin vasodilatation ?Increasing ANP and scavenging free radicals 第13页/共48页Box