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1、ChronicHeartFailurePeople'sHospitalDefinitionofHeartFailureHFisacomplexclinicalsyndromethatcanresultfromanystructuralorfunctionalcardiacdisorderthatimpairstheabilityoftheventricletofillwithorejectblood.是各种心脏结构或功能性疾病导致心室充盈和（或）射血功能受损，心排血量不能满足机体组织代谢需要，已后循环和（
2、或）体循环淤血，器官、组织血液灌注不足为临床表现的一组综合征。心衰的分类TypesofHeartFailureClassificationintermsoflocationLeft,rightandbiventricularheartfailureClassificationintermsofvelocityAcuteandchronicheartfailureClassificationintermsofmechanismSystolicordiastolicheartfailureClinicalma
3、nifestation(leftheartfailure)左心衰竭：主要为肺循环淤血及心排血量降低为主要表现的。Leftheartfailure：mainlymanifestedwithpulmonarycongestionandreductionofcardiacoutput不同程度的呼吸困难①劳累性呼吸困难dyspneaonexertion（最早出现的症状thefirstasymptom）②端坐呼吸orthopnoea③夜间阵发性呼吸困难paroxysmalnocturnaldyspnea:often
4、withwheezesoundinbothlung【心源性哮喘cardiogenicasthma】④急性肺水肿acutepulmonaryedemaClinicalmanifestation(leftheartfailure)Clinicalmanifestation(leftheartfailure)咳嗽、咳痰、咯血Cough,expectoration,hemoptysis乏力、疲倦、头昏、心慌Weakness,fatigueonexertion,dizziness,flustered少尿及肾功能损害
5、Symptomsofoliguriaandimpairedrenalfunction早期为夜尿增多inearlyperiod,nocturiaincrease后期为少尿inlaterperiod,oliguriaClinicalmanifestation(leftheartfailure)Sing肺部湿性罗音moistralesinthebaseoflung心脏体征diffuseandlaterallydisplacedapicalimpulse；gallopinearlydiastolicperiod,
6、accentuatedp2；systolicmurmuratcardiacapex；pulsesalternansoccurwhenleftventricularejectiveimpedanceincreaseClinicalmanifestation(Rightheartfailure)Symptom消化道症状：食欲不振、腹胀、恶心、呕吐Gastrointestinaltractsymptom:anorexia,istention,nausea劳累性呼吸困难dyspneaonexertionClini
7、calmanifestation(Rightheartfailure)Sign水肿edema：istypicalsignofrightheartfailure.atfirstoccurinfoot,ankle,anteriortibia.颈静脉征cervicalfilling，hepaticcervicalreflux肝肿大liverlarge，congestiveliver心脏体征全心衰竭Biventricularheartfailure右心衰竭继发于左心衰竭形成全心衰竭，当右心衰竭出现后,左心衰竭肺淤
8、血症状反而减轻，主要表现为心排血量减少的相关症状和体征。haveclinicalmanifestationofleftandrightheartfailureLaboratoryinvestigation1.利钠肽BNP,NT-proBNPBNPlevelsvarydirectlywithseverityDyspneaduetoCOPD,BNPlevels<100,HF>1,000BNP<100yieldnegativepre
