心瓣膜病与心力衰竭课件

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,*,*,心瓣病蜀心力衰竭,江苏省徐州医学院心血管病研究所,李东野,心瓣膜病,Valvular heart disease,心瓣膜受到各种致病因素损伤或先天发育畸形所,导致的单个或多个瓣膜结构和功能异常,瓣膜口狭窄和或关闭不全,主要累及二尖瓣和主动脉瓣,三尖瓣较少受累,发生率仅次于冠心病,分先天性和获得性两大类,获得性心瓣膜病以风湿性、老年退行性多见,Euro Heart Survey on Valvular Heart Disease,Euro Heart Survey on o,Valvular Heart,A prospective survey of patients with valvular,heart disease in Europe:The Euro Heart Survey,Valvular Heart Disease,签能501 patients堊,=画,Native Valve Disease,Previous Intervention,3547(719,145429%,Aortic Mitral Multiple Right ConservativeValve,Replacement,45%,20%,1%,19%,81%,lung et al.Eur Heart 2003:24:1244-53,Burden of valvular heart diseases:a population-based study,Vuyisile TNkomo,Julius M Gardin,Thomas N Skelton John S Gottdieme,Christopher G Scott,Maur ice Enriquez-Sarano,ackground valvular heart diseases are not usually regarded as a major public health problem.Our aim was to assess Lorswt10063681005-11,eir prevalence and effect on overall survival in the general popul,Methods We pooled population-based studies to obtain data for 11911 randomly selected adults from the general bD 10-193000140,had been assessed prospectively with echocardiography,We also analy sed data from a community,study of 16 501 adults who had been assessed by clinically indicated echocardiography,Findings In the general population group,moderate or severe valve disease was identified in 615 adults.There was ne,=0.90),Prev,o)in the 75 years and older group(p-0.0001).The Stan Medkalcemter,Detrultl,but was diagnosed less often in women than in men(odds ratio 0.90,0.81-1-01:p-0.07).The,morta,Ic ratio associated with,seIse was1.36(1-15-1-62=0.4005)ine,tion and175hm以t,1-61-190,the associated lower survival.valve diseases thus represent an important public-health problem.balance in vie,Mechine,A Prevalence of moderate or severe valve diseases,A Population-based studies in the US with systematic,echocardiography totalling 11,911 adults(CARDIA,ARIC,CHs,x Estimation of overall pr,revalence:2.5%o,Nkomo et al.Lancet 2006:368:1005-11,Single native valve Disease etiology,100%,Other,60%,Ischemic,Congenital,40%,L Inflammatory,Endocarditis,Rheumatic,20%,口 Degenerative,As,AR,MR,MS,lung et al.Eur Heart J2003:24:1244-53,瓣病病因的旗变模式,风湿性瓣膜病,退行性瓣膜病,新出现的类型,时间,E Braunwald AcC 2003,21世纪心脏病学的两大挑战,心力衰竭和心房颤动,心力衰竭:心脏病最后的大战场,正成为21世纪最重要的心血管病症,随看人口的老齡牝,预计到2030年,克血性心力襄竭(CHF)喲惠病率将增加近一倍,心力衰竭造成的负担,RLo,1990,10,2030,推测值,推测值2,1 Cardiology Roundtables estimate based on expert interviews,Projection based on forecasted growth in population,age 45 and above,Source:Aging America:Trends and Projections,1991 Edition,u.Department of Health,ces,Washinton,DC,1,C.Benedict.1997,临床研究,中国部分地区1980、1990、2000年慢性,心力衰竭住院病例回顾性调査,中华医学会心血管病学分会,1980年,1990年,2000年,高血压5.6%,7%,11.0%,冠心病337%,36.5%,53.3%,风心病44.2%,35.8%,16.7%,1980、1990、2000年中国10,795例心力衰竭病人的病因分布,心脏功能的监理基融心力衰竭的发病机制,原发性心肌损害:缺血性心肌损害、心肌炎或,心肌病;心肌代谢障碍(糖尿病性心肌病等),心脏瓣膜关闭不全,高血压,左、右心分流或动静脉分流,全身血容量增加如贫血、甲亢心肌收缩力膜狭窄(半月瓣),前负荷(舒张期容量),心排血量,后负荷(射血阻抗),心脏机械结构完整性,心率,房室收缩协调性,