内科学课件： 心功能不全（英文版）-.pptVIP

HeartFailure

DefinitionofHeartFailureHFisacomplexclinicalsyndrome,inwhichpatientshavetypicalsymptoms(e.g.breathlessness呼吸急促,ankleswllingandfatigue疲劳)andsigns(e.g.elevatedjugularvenouspressure,pulmonarycrackles)resultingfromanabnormalityofcardiacstructureorfunction.

GeneralConsiderationsSystolicfunctionoftheheartisgovernedbyfourmajordeterminants:ContractilestateofthemyocardiumPreloadoftheventricleAfterloadappliedtotheventriclesHeartrate

UnderliningCausesofHeartfailure

---fromaclinicalviewpoint(1)Underlyingcauses,comprisingthestructuralabnormalities—congenitaloracquired—thataffecttheperipheralandcoronaryvessels,myocardium,orcardiacvalvesandleadtotheincreasedhemodynamicburden,increasedmyocardialstress,orcoronaryinsufficiencyresponsibleforheartfailure.

UnderliningCausesofHeartfailure

---fromaclinicalviewpoint(1)Underlyingcauses:SystemichypertensionCoronaryarterydiseaseCardiomyopathyValvularheartdiseaseDiabetesBeriberi

UnderliningCausesofHeartfailure

---fromaclinicalviewpoint(2)Precipitatingcauses,includingthespecificcausedorincidentsthatprecipitateworseningheartfailurein50to90percentofepisodesofclinicalheartfailure.

PrecipitatingCausesofHeartfailureInfection,especiallypulmonaryinfections.Arrhythmias,mostcommonlyatrialfibrillation,markedbradycardia.MyocardialischemiaorinfarctionPulmonaryembolism

PrecipitatingCausesofHeartfailurePhysicalandemotionalstressInappropriatereductionoftherapyAdministrationofmyocardialdepressantorsalt-retainingdrugs

ClinicalClassification1．AcuteVersusChronicHeartFailure2．Right-SidedVersusLeft-SidedFailure3．SystolicVersusDiastolicHeartFailure

ChronicHeartFailure

CausesofHFinWesternWorldForasubstantialproportionofpatients,causesare:CoronaryarterydiseaseHypertensionDilatedcardiomyopathy

ClinicalManifestations

Left-sidedhear