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1、HeartFailure上海交通大学医学院附属仁济医院心内科张清副教授HeartFailure_ZhangQingHeartfailureisthepathophysiologicalstateinwhichtheheartisunabletopumpsufficientbloodtosatisfythemetabolicdemandsofthebodywithenoughpreload.TheProgressiveDevelopment ofCardiovascularDiseaseEndstageHeartDiseaseConges
2、tiveHeartFailureVentricularDilationRemodelingArrhythmia&LossofMuscleMyocardialInfarctionMyocardialIschemiaCADAtherosclerosisEndothelialDysfunctionRiskFactorsCoronaryThrombosisForprogressivedurationCongestiveheartfailureisclassifiedintoacuteandchronicheartfailureCongestiv
3、eheartfailureisclassifiedintoleftside,rightsideandbiventricularheartfailureForanatomicaltypeChronicheartfailureHeartFailure_ZhangQingCausesFundamentalcauses:impairmentofmyocardium,suchasAMI,cardiomyopathy,myocarditisoverloadingoftheheart,suchashypertension,aorticstenosis
4、,mitralstenosis,emphysema,aorticinsufficiency,mitralinsufficiency,VSD,PDA,ASD.diminishedLVcompliance,suchasventricularhypertrophyPrecipitatingfactorsinfection,especiallypulmonaryinfection,feverphysical,environmental,oremotionalstressincreasedsodiumloadarrhythmia,pulmonar
5、yembolipregnancyanddeliveryanemia,bleeding,excessivetransfusionPathophysiologyofheartfailureImpairedmyocardium↓Cardiacoutput↓,heartfailure↓NeurohumoralstimulationRASandsympathetic-adrenergic↑↓↓VasoconstrictionincreasedheartrateSaltandwaterretentionincreasedenergy(augment
6、spreload)expenditureHypertrophy↓LeadstodeteriorationanddeathofcardiaccellEffectsofNeurohormonalStimulationinHeartFailureHeartHeartrateContractilityStrokevolumeCardiacoutputConductionvelocityMyocardialoxygenconsumptionPeripheralCirculationArterialvasoconstrictionVenoconst
7、rictionSystemicvascularresistanceRedistributionofbloodflowRenalvasoconstrictionPathophysiologyofHeartFailure:LeftVentricularRemodelingLeft-ventricular(LV)remodelingisdefinedasachangeinLVgeometry,massandvolumethatoccursoveraperiodoftimeHeartFailure_ZhangQingVentricularRem
8、odeling: CompensatoryMechanismDilationHypertrophyGlobularshapeShortterm:CompensatoryLongterm:HarmfulDET
