HF心衰英文课件Heartfailure(HF)中国心力衰竭流行病学心力衰竭预后狄兰.托马斯”Twonewepidemicsofcardiovasculardiseaseareemerging:heartfailureandatrialfibrillation.”EugeneBraunwaldNEJMNow19972.HF=systolicHFand/ordiastolicHFTheDonkeyAnalogy㈡Fundamentalcauses治疗㈡Fundamentalcauses㈡Fundamentalcauses心脏功能的生理基础㈢Precipitatingcauses㈣Pathogenesisandpathophysiology1.CompensateheartfailureNEnglJMed2003;348:2007-18浓度水平累计死亡率(%)肾上腺素系统活化心力衰竭——神经体液的代偿和失代偿RAAS和交感神经兴奋性↑神经内分泌和细胞因子激活（NE、AngⅡ、醛固酮、加压素、内皮素、TNF）已被以神经内分泌抑制剂为主的新的“常规治疗”或“标准治疗”所取代：ACEI/ARB、受体阻滞剂、利尿剂，有时加用地高辛2.somecytofactorstakepartinheartfailure神经激素平衡调节系统AdaptedfromBurnettJC.JHypertens.1999;17(Suppl1):S37-S43.这时候补充----新活素ＴＭ3.aboutdiastolicinsufficiency㈤CategoriesofHF1.NewYorkHeartAssociationFunctionalClassification2.evidenceofcardiovasculardisease3.e.g.㈦Clinicalmanifestations1.Leftheartfailure1.Leftheartfailure2.Rightheartfailure2.RightheartfailureDefinitionanddiagnosis㈧Diagnosisanddifferentialdiagnosis㈧Diagnosisanddifferentialdiagnosis㈧Diagnosisanddifferentialdiagnosis㈧Diagnosisanddifferentialdiagnosis㈨Treatmentofchronicheartfailure㈨TreatmentofchronicheartfailureNon-pharmacologicalmanagementPeopleinvolvedincareThePlayers调整生活方式心理和精神治疗Pharmacologicaltherapy㈨TreatmentofchronicheartfailureDiuretics利尿剂临床应用利尿剂抵抗㈨TreatmentofchronicheartfailureACEinhibitors血管紧张素转换酶抑制剂(ACEI)ACEI应用方法Contraindication:①anuricrenalfailure②pregnancyandbrestfeedingwoman③allergeACEI不良反应㈨Treatmentofchronicheartfailure地高辛应用要点地高辛不良反应㈨Treatmentofchronicheartfailure②β–adrenegicreceptorsactivatorsa.Dopamine:2-5µg/kg﹒minmyocardialcontractility↑vasculardilatationHR-4)Betablocker:--------improveprognosismetaprololcarvedilolβ受体阻滞剂应用要点β受体阻滞剂应用要点β受体阻滞剂禁忌证5)Aldosterone-receptorsinhibitors--------improveprognosisantistone㈨Treatmentofchronicheartfailure心力衰竭的药物治疗心力衰竭治疗药物Acutecardiacinsufficiency㈡Clinicalmanifestation㈢TreatmentTHEEND