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1、PharmacologicalManagementofCongestiveHeartFailureByDe-changZhangPekingUnionMedicalCollegeEPIDEMIOLOGYOFCHFMostcommoncauseofhospitalizationover65yearsofage. Afflictsmorethan2millionAmericansannually. 900,000hospitalizationperyear.PROGNOSISPoorUntreated,82%ofmen
2、diewithin6yearsofonset.Untreated,67%ofwomendiewithin6yearsofonset.Treated,mortalitywasreducedto40%.射血分数（EjectionFraction，EF)一次心跳由一侧心室射出的血量称为每搏输出量(strokevolume,SV)。每搏输出量占心室舒张末期容积的百分比称为射血分数（EF），在安静状态下，射血分数为55％~65%。SubtypesofCHFLowoutput,diastolicdysfunctionLowou
3、tput,systolicdysfunctionHigh-outputfailure↑metabolicandoxygendemands↑ContractilityHeartsizeleftventricularend-diastolicvolume↑EFstrokevolume↑COHyperthyroidism,Beriberi(脚气病),anemia,arteriovenousshunts(动静脉分流).HIGH-OUTPUTFAILURECharacteristicsContributingfactorsB
4、iologyGlycosidesarenoteffectiveintreatingit.↓contractility(cardiomyopathy) ↑afterload(elevatedSVR,systemicvascularresistance)Hypofunctioningleftventricle; enlargedheart(dilatedleftventricle); ↑leftventricularend-diastolicvolume;↓EF(<40%);↓strokevolume; ↓cardia
5、coutput；Coronaryischemia.MI(myocardialinfarction), Hypertension,aorticstenosis,volumeoverloadLOW-OUTPUTFAILURE（systolic）ContributingfactorsBiologyGlycosidesareeffectiveintreatingit.Characteristics1.Thickenedleftventricle(hypertrophiccardiomyopathy) 2.stiffleft
6、ventricle(restrictivecardiomyopathy左心室硬化) 3.↑preloadNormalntractility; normalheartsize; stiffleftventricle; ↓leftventricularend-diastilicvolume;normalEF;↓SV(strokevolume);1.coronaryischemia,MI,hypertension，pericarditis,enlargedleftventricularseptum2.Amyloidosi
7、s3.SodiumandwaterretentionLOW-OUTPUTFAILURE（diastolic）ContributingfactorsBiology30%to40%ofcasesCharacteristicsCONSEQUENCESOFCHF1.SubnormalCardiacOutput2.NeurohumoralReflexes3.MyocardialHypertrophyCHFmakestheventricularfunctioncruveshiftdownward.VentricularFunc
8、tionCurveTREATMENTOFCHFXANTHINESACEIVASODILATORSLOOPDIURETICSCARDIACGLYCOSIDESEffectofACEIsSignificantlydecreasedmortalityduetoCHFACTION:Inhibittheactivationoftherenin-angiotensins
