Heart Failure
Definition of Heart Failure
HF is a complex clinical syndrome, in which patients have typical symptoms (e.g. breathlessness呼吸急促, ankle swlling and fatigue疲劳) and signs (e.g. elevated jugular venous pressure, pulmonary crackles) resulting from an abnormality of cardiac structure or funcilure
Causes of HF in Western World
For a substantial proportion of patients, causes are:
1. Coronary artery disease 2. Hypertension 3. Dilated cardiomyopathy
Clinical Manifestations
Left-sided heart failure
New York Heart Association Functional Classification
Class I
Patients with cardiac disease but without resulting limitations of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, dyspnea, or anginal pain.
Underlining Causes of Heart failure ---from a clinical viewpoint (2)
• Precipitating causes, including the specific caused or incidents that precipitate worsening heart failure in 50 to 90 percent of episodes of clinical heart failure.
Underlining Causes of Heart failure ---from a clinical viewpoint (1)
• Underlying causes: • Systemic hypertension • Coronary artery disease • Cardiomyopathy • Valvular heart disease • Diabetes • Beriberi
Precipitating Causes of Heart failure
• Physical and emotional stress • Inappropriate reduction of therapy • Administration of myocardial depressant or
General Considerations
Systolic function of the heart is governed by four major determinants:
• Contractile state of the myocardium • Preload of the ventricle • Afterload applied to the ventricles • Heart rate
salt-retaining drugs
Clinical Classification
1．Acute Versus Chronic Heart Failure 2．Right-Sided Versus Left-Sided Failure 3．Systolic Versus Diastolic Heart Failure
New York Heart Association Functional Classification
Class II
Patients with cardiac disease resulting in slight limitation of physical activity. They are comfortable at rest. Ordinary physical activity results in fatigue, palpitation, dyspnea, or anginal pain.
Underlining Causes of Heart failure ---from a clinical viewpoint (1)
• Underlying causes, comprising the structural abnormalities—congenital or acquired—that affect the peripheral and coronary vessels, myocardium, or cardiac valves and lead to the increased hemodynamic burden, increased myocardial stress, or coronary insufficiency responsible for heart failure.
Precipitating Causes of Heart failure
• Infection, especially pulmonary infections. • Arrhythmias, most commonly atrial
fibrillation, marked bradycardia. • Myocardial ischemia or infarction • Pulmonary embolism