心力衰竭内科疾病课件

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1、HeartFailureADiseasefortheInternistDrChrisDavidsonSussexCardiacCentreBRIGHTONUKHeartFailure–atypicalcase?MedicalAssessmentUnit78yearoldwomanHypertension;typeIIDiabetesAF110/min,180/80,JVP+,oedema++CXR:cardiomegaly,pulmonarycongestionECG:AF,LBBBGivenivFrusemide80mgwitha‘good’diuresisandfeels

2、bettertoday2EFIMBeziers2007HeartFailureADiseasefortheInternistWholooksafterpatientswithHeartFailure?UseofEvidence-basedTreatmentsTheproblemofHeartFailurewith‘Preserved’LVfunctionCo-MorbidityinHeartFailureHowdowepreventearlyrelapse?3EFIMBeziers2007EuroHeartFailureSurvey11,327diagnosisHFMeana

3、ge71years;47%womenGIM/geriatrics55%,cardiology45%CHD66%,Valvedisease29%,DCM5%HFprinciplereasonforadmissionin40%LVSDin46%:male>femaleEuropeanHeartJournal(2003)24,442–463Registryof46,786consecutiveadmissionstogeneralmedicineandcardiologywardsin24Europeancountriesovera6weekperiod2001-24EFIMBez

4、iers2007HeartFailureinFranceCohen-SolaletalEuropeanHeartJournal(2000)21,763–7695EFIMBeziers2007HEARTFAILUREHowSerious?EpidemiologyofHeartFailure:FraminghamStudyHypertension76%79%CHD46%27%Rheumatic2%3%Other11%17%MORTALITY82%67%(6Year)MALEFEMALEHoetalCirculation1993;88:107-1157EFIMBeziers200

5、7MOREMALIGNANTTHANCANCER?StewartSetal.Eur.JHeartFailure(2001)3315-322Reference:Stewartetal.EurJHeartFailure2001FiveyearSurvivalofPatientsadmittedtoHospitalinScotland199128%28%8EFIMBeziers2007HEARTFAILUREWhataretherecommendedtreatments?HF–TrialEvidenceACEinhibitorsVasodilators:Hydrallazine/N

6、itrateBeta-BlockersSpironolactoneAngiotensinReceptorBlockersExerciseTrainingBiventricularPacing/DefibrillatorsCardiacTransplantation10EFIMBeziers2007MortalityBenefitofTreatmentsinHeartFailure6mo3.5yr6mo1.3yr1yr2yr11EFIMBeziers2007EuroHeartFailureSurvey:UseofACEIandBB12EFIMBeziers2007Guideli

7、nesfortheTreatmentofHeartFailureAmericanHeartAss./AmericanCollegeofCardiologyChronicHeartFailure2005JAmCollCardiol2005;46:1116-43EuropeanSocietyofCardiologyChronicHeartFailure2005EHJ2005;26:1115-1140EuropeanSocietyofCardiologyAcuteHeartFailure2005EHJ2005