资源描述
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,*,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,Heart failure,1,1,DEFINITION,HEART FAILURE,A clinical syndrome in which an abnormality of cardiac structure or function is responsible for the inability of the heart to eject or fill with blood at a rate commensurate with the requirements of the metabolizing tissues. Heart failure results in a constellation of clinical manifestations, including circulatory congestion, dyspnea, fatigue, and weakness.,2,DEFINITIONHEART FAILURE 2,FORMS OF HEART FAILURE,Systolic vs diastolic heart failure,Low-output vs high-output heart failure,Acute vs chronic heart failure,Right-sided vs left-sided heart failure,3,FORMS OF HEART FAILURESystolic,UNDERLYING CAUSES,Ischemic heart disease,Cardiomyopathies,Congenital, valvular and hypertensive heart disease (potential treatable ),4,UNDERLYING CAUSES Ischemic hea,PRECIPITATING FACTORS,Infection,Arrhythmias,Physical, dietary, fluid, environmental, and emotional excesses,Myocardial infarction,Pulmonary embolism,Anemia,Thyrotoxicosis and pregnancy,Aggravation of hypertension,Rheumatic, viral, and other forms of myocarditis,Infective endocarditis,5,PRECIPITATING FACTORS Infectio,PATHOGENESIS,Chronic hemodynamic overloadeccentric ventricular hypertrophy,Chronic pressure overload concentric ventricular hypertrophy,Ventr. hypertrophy ventr. Dilatation,Remodeling of ventricle HF,Activation of endogenous neurohormonal system and cytokines,6,PATHOGENESISChronic hemodynami,“,7,“ 7,CLINICAL MANIFESTATION OF HF,Primary,Symptoms,Dyspnea,Orthopnea,Paroxysmal (nocturnal) dyspnea,Acute pumnonary edema,8,CLINICAL MANIFESTATION OF HF,CLINICAL MANIFESTATION OF HF,Other symptoms,Fatigue and weakness,Abdominal symptoms,Cerebral symptoms,9,CLINICAL MANIFESTATION OF HFOt,PHYSICAL FINDINGS OF HF,General findings,Pulse pressure （severe HF), SBP with cool, diaphoretic extremities, and Cheyne -Stokes respiration,Cyanosis, sinus tachycardia,10,PHYSICAL FINDINGS OF HFGeneral,PHYSICAL FINDINGS OF HF,Cardiovascular findings,S,3,and,S,4,Cardiomegaly,Murmurs,Pulsus alternans,Distention of j v. (systemic v. p),11,PHYSICAL FINDINGS OF HF Cardio,PHYSICAL FINDINGS OF HF,Pulmonary rales,Cardiac edema,Symmetric and dependent in the legs,Most prominet in evening,Hydrothorax and ascites,Congestive hepatomegaly.,12,PHYSICAL FINDINGS OF HFPulmona,LABORATORY EXAMINATION,N-terminal-pro-BNP and BNP,Two-dimensioanl echocardiography with Doppler flow studies,Chest roentgenogram,ECG,13,LABORATORY EXAMINATIONN-termin,Echocardiogram,2D echo with Dopler technique for systolic and diastolic function of LV,LVDd and LVDs（Dd and Ds）,LVEF,14,Echocardiogram 2D echo with Do,DIAGNOSIS OF HF,Combination of the clinical manifestation of HF, together with the findings characteristic of one of the underlying forms of heart disease.,15,DIAGNOSIS OF HF Combination of,DIFF. DIAGNOSIS OF HF,Pulmonary disease,Pulmonary embolism,Ankle edema,Enlargement of the liver and ascites,16,DIFF. DIAGNOSIS OF HFPulmonar,TREATMENT OF HF,Correction of the underlying cause,Removal of the precipitating cause,Prevention of deterioration of cardiac function,Control of the congestive HF state,17,TREATMENT OF HFCorrection of t,GENERAL MEASURES,Treating coronary risk factors,Moderate dietary Na restriction,Daily measurement of weight,Prevent respiratory infection,Avioding excessive alcohol,temperature extremes, and tiring,trips,GENERAL MEASURES Treating co,TREATMENT OF HF,Control of excessive fluid,Diet,Diuretics,Thiazide diuretics,Metolazone,Frusemide,Bumetanide,torsemide,Potassium-sparing diuretics,19,TREATMENT OF HFControl of exce,TREATMENT OF HF,Blockade of renin-angiotensin-aldosterone and adrenergic system,ACE inhibitors,Angiotensin receptor blockers,Beta-adrenoceptor blockers,Aldosterone antagonist,20,TREATMENT OF HFBlockade of ren,TREATMENT OF HF,Enhancement of myocardial contractility,Digitalis,Sympathomimetic amines,Phosphodiesterase inhibitors,21,TREATMENT OF HFEnhancement of,TREATMENT OF HF,Vasodilators,Nitrates,Nitroglycerine,Isosorbide dinitrate,Mononitrates,Nitroprusside,nesiritide,22,TREATMENT OF HFVasodilators22,TREATMENT OF HF,Ventricular resynchronization,Management of arrhythmia,Anticoagulants,Refractory heart HF,Assisted circulation/cardiac transplant.,23,TREATMENT OF HFVentricular res,STAGE A,At high risk for HF but without structural heart disease or symptoms of HF.,Treat hypertension,Encourage smoking cessation,Treat lipid disorders,Encourage regular exercise,Discourage alcohol intake, illicit drug use,Control metabolic syndrome,ACEI or ARB in appropriate patients for vascular disease or diabetes,24,STAGE AAt high risk for HF but,STAGE B,Structural heart disease but without signs or symptoms of HF,All measures under Stage A,ACEI or ARB in appropriate patients,Beta-blockers in appropriate patients,25,STAGE BStructural heart diseas,STAGE C,Structural heart disease with prior or current symptoms of HF.,All measures under Stages A and B,Dietary salt restriction,DRUGS FOR ROUTINE USE,Diuretics for fluid retention,ACEI,Beta-blockers,DRUGS IN SELECTED PATIENTS,Aldosterone antagonist,ARBs,Digitalis,Hydralazine/nitrates,DEVICES IN SELECTED PATIENTS,Biventricular pacing,Implantable defibrillators,26,STAGE C26,STAGE D,Refractory HF requiring specialized interventions.,Appropriate measures under Stages A, B, C,Decision re: appropriate level of care,OPTIONS,Compassionate end of-life care/hospice,Extraordinary measures,heart transplant,chronic inotropes,permanent,mechanical support,experimental,surgery or drugs,27,STAGE DRefractory HF requiring,PROGNOSIS OF HF,Depend on,Nature of the underlying heart,disease,Presence of a treatable,precipitating factor,The response to treatment,28,PROGNOSIS OF HFDepend on 28,谢 谢,29,谢 谢29,docin/sanshengshiyuan,doc88/sanshenglu,更多精品资源请访问,docin/sanshengshiyuan 更多精品,
展开阅读全文