医学课件心衰的代偿机制

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1、CompensatoryMechanismstoHeartFailure王刚张萨丽陶萄罗碧芬病例1www.themegallery.comCompensatoryMechanismstoHFNeurohumoralActivationFunctionalAdjustmentHeartFailureABExtracardialCompensationDStructuralAdaptationCwww.themegallery.comA.NeurohumoralActivationRAASSympatheticNervousSystemNAHRCOResistancevess

2、elconstructionPerfusionpressureβ-Rα-RAngII(+)AldADHVesselconstructionH2O&Na+retentionVenousreturnCOHF(+)www.themegallery.comA.NeurohumoralActivationRAASSympatheticNervousSystemNAAngIIHFlong-termβ-Rdesensitize&NAreductionVenousreturnVesselconstructionPreloadAfterloadwww.themegallery.comRen

3、inA.NeurohumoralActivationANFBNPHFRasodilatationH2O&Na+AldADHResistancevesselconstructionofSNS（-）（-）（-）www.themegallery.comB.FunctionalAdjustmentIncreasedHeartRateIncreasedPreloadIncreasedContractilityCardiacOutputCOBPCerebralvessels&coronaryarteryperfusionFrank-StarlingLawLmax=2.2μmNAβ-R

4、cAMPPKACa2+channelproteinphosphorylationCytoplasmCa2+www.themegallery.comB.FunctionalAdjustmentIncreasedHeartRateIncreasedPreloadIncreasedContractilityoxygen-consumptioncoronaryarteryperfusion{L>3.6μmcontractibilitywww.themegallery.comC.StructuralAdaptation心肌重塑Myocardialremodeling由于心肌细胞、非

5、心肌细胞及细胞外基质在基因表达改变的基础上所发生的变化，使心脏的结构、代谢和功能经历的模式重塑的过程www.themegallery.comC.StructuralAdaptationConcentricHypertrophyEccentricHypertrophyMyocardialHypertrophyMyocardialcellthickeningVentricularwallthickeningVolumeofchambersnormalLengthofMyocardialcellincreasesVentricularwallthickeningVolumeof

6、chambersincrease1Myocyteremodelingwww.themegallery.comC.StructuralAdaptationMyocardialHypertrophyContractilityCOsustainingTensionofventricularwalloxygenconsumptionHypoxiaDisorderofenergymetabolismContractilityMyocytelossStructuralalterationsofmyocardiumDilatationofventriclewww.themegaller

7、y.comC.StructuralAdaptationChangesinmyocytephenotype胎儿期基因另一些基因转型的心肌细胞和非心肌细胞cytokinelocalhormonechemicalsignalmechanicalload蛋白质分子水平变化secretepromotewww.themegallery.comC.StructuralAdaptationfibroblastVSMCextracellularmatrixendothelialcellNon-Myocyte2ChangesinNon-Myocy