心力衰竭精编版.ppt

causes of heart failure 尤其是快速型心律失常 心率↑ ? 舒张期缩短 心肌耗氧量↑ 冠脉血流↓ ? 心肌缺血、缺氧 ? 心室充盈↓ 心泵功能↓ ? 心输出量↓ 妊娠期血容量↑（临产期↑）→ 分娩时疼痛、精神紧张、 ↓ ↓ 稀释性贫血 交感一肾上腺髓质系统兴奋 高动力循环状态 ↓ 静脉回流↑ 小血管收缩 心脏前负荷↑ （左室）后负荷↑ 心肌耗氧量↑和冠脉流量↓ ? ↓ 心输出量↓ 5. Excessively labor and spiritual burden; infusion High-output heart failure: the output of the heart may be supra-normal but inadequate owing to excessive metabolic needs. Causes of high-output failure include severe anemia, hyperthyroidism and pregnancy. Concentric hypertrophy: is the response to pressure overload. It is associated with increased number of sarcomere arranged in parallel. The increase in wall thickness reduces wall tension and cardiac compliance without increasing the internal chamber size. 心力衰竭与机体的代偿模式图 myocardial cell apoptosis : apoptotic index 35.5% 心肌收缩性下降的机制小结 心肌舒张性下降的机制小结 心衰发生机制小结 临床表现 1) 毛细血管压↑ 左心衰→左室舒张末期压力↑→肺毛细血管压↑ 超过其代偿能力→肺水肿 2) 毛细血管通透性↑　 体循环淤血 着眼点从传统的改善血流动力学，减轻症状——“强心、利尿、扩血管”到改善预后，降低总死亡率——针对过度激活的神经、内分泌系统（交感神经、肾素-血管紧张素-醛固酮系统），进行“修复” 药物强心甙地位?利尿剂、转化酶抑制剂、β-阻滞剂地位? Reduced Ca2+ reserved by SR Mitochondria uptake Ca2