右心衰竭PPT幻灯片.ppt

* And complex anatomy means complex physiology. Because the contraction of RV corpus and conus is not simultaneous but there is a 20-40 ms gap (so it is simil-peristaltic). And the ejection of blood from RV is therefore not due to contraction of the walls toward center of gravity (as for LV) but due to: 1) bellow movement (RV free wall squeezing toward septum) e 2) base to apex excursion of the tricuspid annular plane * This slide represents a synthesis of human and animal models of PAH that shows a putative model of disease progression. Pulmonary hypertension may be classified into 3 rough categories, pre-symptomatic/compensating, symptomatic/decompensating, and declining/decompensated. In this hypothetical model, as the vascular pathology progresses (proliferation of intima, hyperplasia of the SMC, and adventicial fibrosis), PVR increases and pulmonary artery pressure rises in concert in order to maintain CO. As long as the RV is able to compensate for the resistance, pressure continues to increase as PVR increases. The increased RV work-load causes the RV to hypertrophy and its efficiency falls, right heart failure ensues, and PAP will fall as the patient decompensates. Failure to maintain CO leads to the symptoms of the disease and ultimately right heart dysfunction and death CO- Cardiac Output PAP- Pulmonary arterial pressure PVR- Pulmonary vascular resistance * * prostanoid * 右心衰竭诊治进展 国家心血管病中心 阜外心血管病医院 心血管内科 肺血管病诊治中心 熊长明 右心衰竭病因复杂，涉及多个学科。 不同病因的右心衰竭的病情发展、处理以及预后差异大。 超声评估右心功能不是临床常规检查项目，客观检查准确性欠佳。 右心衰竭的治疗措施有限，相应的循证医学证据不多。 2009年《加拿大心血管病学会2009心力衰竭更新共识》，将右心衰竭诊断和治疗的内容作为独立的章节列出。 2007年中国《慢性心力衰竭诊断和治疗指南》没有涉及右心衰竭的诊断和治疗。 2010年中国《急性心力衰竭诊断和治疗指南》仅包含了急性右心衰竭的内容。 2014《中国心力衰竭诊断和治疗指南2014》将右心衰竭诊断和治疗的内容作为独立的章节列出。 右心衰竭的定义 右心衰竭（RHF）是指右心收缩和/或舒张功能障碍，不足以产生机体所需要的心排出量或不能形成正常充盈压时所出现的一种临床综合征。 RHF的诊断至少具备两个特征： 与RHF一致的症状与体征； 右侧心脏结构和/或功能异常，或具有心内压增加的客观依据。 * 右心衰竭的病因 压力负荷过重 肺动脉高压 肺动脉栓塞 左心衰竭 右室流出道梗阻 外周肺动脉狭窄 容量负荷过重 三尖瓣反流 肺动脉瓣反流 房间隔缺损 肺静脉畸形引流 主