HF心衰英文课件.pptVIP

Heart Failure (HF) 李纯 Heart failure (HF) ㈠ Meaning of HF 1.Conception : heart failure is a final common pathway for many cardiac disorders of diverse etiology and pathogenic mechanisms. It is a clinical syndrome, manifested as a result of the inability of the heart to match its output to the metabolic needs of the body even though the filling pressure of the heart is adequate. 中国心力衰竭流行病学 推算我国目前成年人中约400万心衰患者 随着年龄增加，心力衰竭患病率显著上升 城市＞农村，北方＞南方，与我国冠心病和高血压的地区分布一致 冠心病和高血压是心力衰竭的主要病因 心力衰竭预后 过去40年，心衰导致的死亡增加6倍（AHA 2005） 2007年中国心衰诊疗指南指出，有临床症状的患者5年生存率与恶性肿瘤相仿 25% 新发心力衰竭患者在1年内死亡 (ESC 1999） 心力衰竭反复入院治疗很常见，超过50% 患者半年内即再入院治疗 (Krumholz et al. 1997, Vinson et al. 1990, Burns et al. 1997) 2.HF=systolic HF and/or diastolic HF 3.HF and cardiac dysfunction (1) cardiac dysfunction = systolic dysfunction or diastolic dysfunction via instrumental examination without signs (2)HF= cardiac dysfunction +signs The Donkey Analogy Ventricular dysfunction limits a patients ability to perform the routine activities of daily living… ㈡ Fundamental causes 1. primary decreased myocardial contractility such as coronar heart disease (hungry) myocarditis ,cardiomyopathy. (injury) ㈡ Fundamental causes 2. increased burdens to the heart ①increased afterload (pressure load): hypertension aortic stenosis pulmonary stenosis pulmonary hypertension . ㈡ Fundamental causes ②increased preload (volume load): mitral incompetence aortic incompetence tricuspid incompetence atrial septal defect (ASD) ventricular septal defect (VSD) (PDA) hyperthyroidism anemia 心脏功能的生理基础 ㈢ Precipitating causes 1. infection ,especially respiratory infection 2.arrhythmias 3.physical or emotional excesses e.g. pregnancy and delivery 4.rapid intravenous infusion ,excessive salt taking 5.electrolyte imbalance 6.primary disease deterioration or a new disease happens ㈣ Pathogenesis and pathophysiology 1.Compensate heart failure 2.some cy