ESC慢性心衰指南PPT课件.ppt

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1、Relationshipbetweencardiacdysfunction,HFandHFrenderedasymptomaticNORMALCARDIACDYSFUNCTIONCORRECTEDORRESOLVEDCARDIACDYSFUNCTIONSYMPTOMSHEARTFAILURETHERAPYTherapyCANbewithdrawnwithoutrecurrenceofsymptomsSymptomsrelievedTherapyCANNOTbewithdrawnwithoutrecurrenceofsymptomsTransie

2、ntHeartFailureNosymptomsAsymptomaticcardiacdysfunctionSystolicdysfunctionSymptomspersistDiagnosisAccordingtotheWorkingGroupinHeartFailure,HeartFailureisasyndromewherethediagnosishasthefollowingessentialcomponents:Acombinationof:Symptoms,typicallybreathlessnessorfatigueCardiacd

3、ysfunctiondocumentedatrestThediagnosisissupportedby:ResponsetotreatmentdirectedtowardsheartfailureAssessmentsinallcasesNecessarySupportsOpposesHistorywithsymptoms+++IfabsentObjectiveevidence+++IfabsentResponsetotreatment++EstablishdiagnosisTestNecessarySupportsOpposesElectrocardiogr

4、am++IfnormalEchocardiography+++IfnormalChestx-rayIfcongestionIfnormalBloodcountIfnormalBloodchemistryIfnormalTestsforDiagnosisAdditionalTestsforDiagnosisTestNecessarySupportsOpposesExercisetestIfnormalNatriureticpeptideIfelevatedIfnormalCardiaccath.IfnormalTesttoExcludeAlternativesC

5、hestx-ray(Lungdisease)PulmonaryfunctionBloodchemistry(Renalandhepaticdisease)Bloodcount(Anaemia)Exercisetolerance(ifimpaired)ElectrocardiographyAnormalECGsuggeststhatthediagnosisofheartfailureshouldbecarefullyreviewed.ThepredictivevalueofanormalECGtoexcludeLVsystolicdysfunctionexcee

6、ds90%ChestX-rayAhighpredictivevalueofX-rayfindingsisonlyachievedbyinterpretingtheminthecontextofclinicalfindingsandECGanomalies.ItisusefultodetectcardiacenlargementandpulmonarycongestionInchronicheartfailure,increasedcardiacsizeandpulmonaryvenouscongestionareusefulindicatorsofabnorm

7、alcardiacfunctionwithdecreasedejectionfractionand/orincreasedLVfillingpressureHowever,cardiomegalyisfrequentlyabsentinacuteheartfailureandincaseswithdiastolicdysfunctionPulmonaryfunctiontestsMeasurementsoflungfunctionareoflittlevalueindiagnosingchronicheartfailure.However,theyareuse

8、fulinexcludingrespi