充血性心衰的治疗PPT课件.ppt

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1、CurrentManagementofCongestiveHeartFailure:2004UpdateHishamDokainish,MD,FACCAssistantProfessorofMedicineBaylorCollegeofMedicine,Director,Non-InvasiveCardiology,BenTaubGeneralHospitalHouston,Texas,USATheProblem(USA)•5,000,000patients•6,500,000hospitaldays/year•300,000deaths/year•6%-10%ofpeopl

2、e>65years•5.4%ofhealthcarebudget(38billion)•Incidencex2inlasttenyearsGottdienerJetal.JACC2000;35:1628HaldemanGAetal.AmHeartJ1999;137:352KannelWBetal.AmHeartJ1991;121:951O’ConnellJBetal.JHeartLungTransplant1993;13:S107DefinitionofheartfailureAHA/ACCHFguidelines2001Clinicalsyndromethatcanresu

3、ltfromanystructuralorfunctionalcardiacdisorderthatimpairstheabilityoftheventricletofillwithorejectbloodSuspectedHeartFailurebecauseofSYMPTOMSand/orSIGNSAssesspresenceofCARDIACDISEASEbyECG,X-RayorBNPTestsabnormalVENTRICULARFUNCTIONImagingbyEcho-Doppler,NuclearangiographyorMRIifavailableTests

4、abnormalNORMALNoHeartFailureNORMALNoHeartFailureHeartFailure:Systolic/DiastolicIdentifyetiology,evaluateseverity,choosetherapyESCHFguidelines2001HeartdiseaseNosymptomsHFRiskFactorsNoHeartdiseaseNosymptomsAsymptomaticLVdysfunctionRefractoryHFsymptomsPriororcurrentHFSymptomsStagesintheevoluti

5、onofHeartFailureABCDAHA/ACCHFguidelines2001ACE-iblockersTreatriskfactorsDietandexerciseAvoidtoxicsACE-iinselectedp.InselectedpatientsPalliativetherapyMech.AssistdeviceHeartTransplantACE-iblockersDiuretics/DigitalisStagesintheEvolutionofHeartFailureTreatmentABCDAHA/ACCHFguidelines2001Aggra

6、vatingFactorsMedicationsNewheartdiseaseMyocardialischemiaEndocarditisObesityHypertensionPhysicalactivityDietaryexcessPregnancyArrhythmias(AF)InfectionsThromboembolismHyper/hypothyroidismInitial/OngoingEvaluationIdentifyheartdiseaseAssessfunctionalcapacity(NYHA,6minwalk,…)Assessvolumestatus:

7、(edema,rales,jugular,hepatomegaly,bodyweight)Labassessment:routine:electrolytes,renalfunct.RepeatEcho,RXonlyifsignificantchangesinfunctionalstatusAssessprognosis8070605040302054-60>6050403020100PostMIn=196<3031-3536-4546-53CardiacMortality%LVEFBrodieB.e