治疗
㈡ Fundamental causes
2. increased burdens to the heart
①increased afterload (pressure load): hypertension aortic stenosis pulmonary stenosis pulmonary hypertension .
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)
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
1. 中华心血管病杂志 2007; 35(12): 1076-95. 2. 顾东风等. 中华心血管病杂志 2003; 31(1): 3-6.
ቤተ መጻሕፍቲ ባይዱ 心脏功能的生理基 础
→心力衰竭的基本病因
心肌炎或心肌病
原发性心肌损害：缺血性心肌损害
心脏瓣膜关闭不全、血液返流 左、右心分流或动静脉分流 全身血容量增加，如贫血、甲亢
心肌代谢障碍 （糖尿病性心肌病等）
心肌收缩力
高血压、瓣膜狭窄（半月瓣）
前负荷 （舒张期容量） 心脏机械结 构完整性
心排血量
心率
后负荷 （射血阻抗）
Let’s compare our heart to this donkey, and our body to the wagon
that this donkey has to pullevery day.
㈡ Fundamental causes
1. primary decreased myocardial contractility such as coronar heart disease (hungry) myocarditis ,cardiomyopathy. (injury)
狄兰.托马斯
詹姆斯.门罗
聂荣臻
蒋介石 叶利钦
詹姆斯.布朗 伊丽莎白.泰勒
心力衰 竭——心 脏疾病的 最后战场 E Braunwald ACC 2003
”Two new epidemics of cardiovascular disease are emerging: heart failure and atrial fibrillation.”
Eugene Braunwald NEJMNow 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 patient's ability to perform the routine activities of daily living…
HF心衰英文课 件
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.
㈡ Fundamental causes
②increased
preload (volume load): mitral incompetence aortic incompetence tricuspid incompetence atrial septal defect (ASD) ventricular septal defect (VSD) (PDA) hyperthyroidism anemia
pensate heart failure
㈣ Pathogenesis and pathophysiology
pensate heart failure 2.some cytofactors take part in heart failure 3.about diastolic insufficiency 4.ventricular remodeling
房室收缩 协调性
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