右心衰竭的诊断与治疗.ppt

. * * * * 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 prognosis in systolic HF and that the estimation of RVEF should be considered as part of a comprehensive assessment of these patients. Baseline RVEF is a significant independent predictor of mortality and HF hospitalization in systolic HF Methods and Results—We examined the effect of baseline RVEF on outcomes in 2008 Beta-Blocker Evaluation of Survival Trial (BEST) participants with HF and LVEF35% during 24 months of mean follow-up. RVEF, estimated by gated-equilibrium radionuclide ventriculography, was used to categorize patients into 4 RVEF groups: 40% (n=733), 30% to 39% (n=531), 20% to 29% (n=473), and20% (n=271). Unadjusted rates for all-cause mortality in patients with RVEF 40%, 30% to 39%, 20% to 29%, and 20% were 27%, 32%, 35%, and 47%, respectively. When compared with patients with RVEF 40%, unadjusted hazard ratios and 95% confidence intervals for all-cause mortality for those with RVEF 30% to 39%, 20% to 29%, and 20% were 1.