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单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,男性63岁工程师,高血压史十余年,无其它病史可供参考,近两年来,体力下降,上7楼感吃力,夜,尿,时有头痛、眼花。,三天前受凉后,发烧,体温39C,昨,晚不能平卧入睡,今早突感呼吸急促,男性63岁工程师,1,心,HEART FAILURE,Dr Ye Duyun(叶笃筠),Department of Pathophysiology,Tongii Medical College of HUST,心,2,Introduction,Percentage of Population,- Prevalence:,with heart failure,4.8 million U residents,12,Hospital admissions:,3.5 million annually,MD office visits:,1 1 million annually,Health expenditures:,中20-40 billion annually,Age Groups,口 All Ages丶655,Introduction,3,Chronic Congestive Heart Failure,LmtEniru,DETERMINANTS OF,VENTRICULAR FUNCTION,CONTRACTILITY,PRELOAD,AFTERLOAD,STROKE,VOLUME,SynergIstic LV contraction,HEART,Lv wall integrity,RATE,-Valular competence,CARDIAC OUTPUT,Chronic Congestive Heart Failu,4,心肌收缩/舒张,CO下降,后向衰端功能下降向,不能满足机,问题,体代谢需要,心包慎塞,大面积心肌梗死,体克,心肌收缩/舒张,5,Chronic Congestive Heart Failur,wenfu,EVOLUTION OF,CLINICAL STAGES,NORMAL,No symptoms. Asymptomatic,Normal LV ixn LV Dysfunction,No symptom, Compensated,Ahnormal Lv trn,CHE,No symptoms Decompensated, Exorcise,Abnormal Lv ixn,CHE,Symptom,L Exercise,Refractory,Abnormal Lv Txn,CHF,symptoms not controlled,wIth trentment,Chronic Congestive Heart Failu,6,心力派竭寂原的,心肌舒缩功能障碍,心肌负荷过重,心肌损伤代谢异常容量负荷增加压力负荷增加,心肌炎vitB1缺乏动脉关闭不全高血压,心肌病缺血、缺氧室间隔缺损,肺动脉高压,动脉瓣狭窄,心肌中毒,慢性贫血,肺栓塞,心肌梗死,甲亢,心肌纤维化,心力派竭寂原的,7,Etiology of Cardiac Dysfunction,Heart disease,Hypertension,Cardiomyopathy, Valvular,Precipitating factors,Etiology of Cardiac Dysfunctio,8,心联之,全身感染,酸碱失衡H+增加,交感神经兴奋,代谢率增加钙内流,内毒素拟交感作用,损害心肌浆网释放,脏,抑制ATP酶活性,心率增加氧耗增加,扩张外周血管,心肌舒张时间缩短,回心血下降,呼吸增加氧耗增加,心联之,9,高钾血症,血钾增高,抑制钙內流,心肌收缩下降,单向传导阻滞,心律失常,心律失常冠脉血流减少,率增加,心室充盈下降,心输出量减少,高钾血症,10,心力衰竭发生机制课件,11,心力衰竭发生机制课件,12,心力衰竭发生机制课件,13,心力衰竭发生机制课件,14,心力衰竭发生机制课件,15,心力衰竭发生机制课件,16,心力衰竭发生机制课件,17,心力衰竭发生机制课件,18,心力衰竭发生机制课件,19,心力衰竭发生机制课件,20,心力衰竭发生机制课件,21,心力衰竭发生机制课件,22,心力衰竭发生机制课件,23,心力衰竭发生机制课件,24,心力衰竭发生机制课件,25,心力衰竭发生机制课件,26,心力衰竭发生机制课件,27,心力衰竭发生机制课件,28,心力衰竭发生机制课件,29,心力衰竭发生机制课件,30,心力衰竭发生机制课件,31,心力衰竭发生机制课件,32,心力衰竭发生机制课件,33,心力衰竭发生机制课件,34,心力衰竭发生机制课件,35,心力衰竭发生机制课件,36,心力衰竭发生机制课件,37,心力衰竭发生机制课件,38,心力衰竭发生机制课件,39,心力衰竭发生机制课件,40,心力衰竭发生机制课件,41,心力衰竭发生机制课件,42,心力衰竭发生机制课件,43,心力衰竭发生机制课件,44,
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