充血性心衰的治疗.ppt

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1、CurrentManagementofCongestiveHeartFailure:2004UpdateTheProblem(USA)•5,000,000patients•6,500,000hospitaldays/year•300,000deaths/year•6%-10%ofpeople>65years•5.4%ofhealthcarebudget(38billion)•Incidencex2inlasttenyearsGottdienerJetal.JACC2000;35:1628HaldemanGAetal.AmHeartJ19

2、99;137:352KannelWBetal.AmHeartJ1991;121:951O’ConnellJBetal.JHeartLungTransplant1993;13:S107DefinitionofheartfailureAHA/ACCHFguidelines2001ClinicalsyndromethatcanresultfromanystructuralorfunctionalcardiacdisorderthatimpairstheabilityoftheventricletofillwithorejectbloodSus

3、pectedHeartFailurebecauseofSYMPTOMSand/orSIGNSAssesspresenceofCARDIACDISEASEbyECG,X-RayorBNPTestsabnormalVENTRICULARFUNCTIONImagingbyEcho-Doppler,NuclearangiographyorMRIifavailableTestsabnormalNORMALNoHeartFailureNORMALNoHeartFailureHeartFailure:Systolic/DiastolicIdentif

4、yetiology,evaluateseverity,choosetherapyESCHFguidelines2001HeartdiseaseNosymptomsHFRiskFactorsNoHeartdiseaseNosymptomsAsymptomaticLVdysfunctionRefractoryHFsymptomsPriororcurrentHFSymptomsStagesintheevolutionofHeartFailureABCDAHA/ACCHFguidelines2001ACE-iblockersTreatrisk

5、factorsDietandexerciseAvoidtoxicsACE-iinselectedp.InselectedpatientsPalliativetherapyMech.AssistdeviceHeartTransplantACE-iblockersDiuretics/DigitalisStagesintheEvolutionofHeartFailureTreatmentABCDAHA/ACCHFguidelines2001AggravatingFactorsMedicationsNewheartdiseaseMyocard

6、ialischemiaEndocarditisObesityHypertensionPhysicalactivityDietaryexcessPregnancyArrhythmias(AF)InfectionsThromboembolismHyper/hypothyroidismInitial/OngoingEvaluationIdentifyheartdiseaseAssessfunctionalcapacity(NYHA,6minwalk,…)Assessvolumestatus:(edema,rales,jugular,hepat

7、omegaly,bodyweight)Labassessment:routine:electrolytes,renalfunct.RepeatEcho,RXonlyifsignificantchangesinfunctionalstatusAssessprognosis8070605040302054-60>6050403020100PostMIn=196<3031-3536-4546-53CardiacMortality%LVEFBrodieB.etalAmJCardiol1992;69:1113PrognosisTreatment

8、ObjectivesSurvivalMorbidityExercisecapacityQualityoflifeNeurohormonalchangesProgressionofCHFSymptoms(Co