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1、老年人慢性心力衰竭的处置及社区管理中南大学湘雅二医院屈晓冰2心力衰竭定义心脏结构或功能的异常心室充盈或射血能力受损症状:呼吸困难乏力体征:肺部湿罗音颈静脉压力升高水肿引起心衰的原发病：冠心病心肌病风湿性心瓣膜高血压病PrevalenceofHeartFailurebyAgeandSexinCHSHFispredominantlyadisorderoftheolderadultpopulationandofthegreaterthan5millionadultswithHFintheUnitedStates,50%areatleast75y
2、earsofage..HeartFailureinOlderAdultsCharacteristicOlderAdultsMiddleAgedPrevalence~10%<1%GenderPredominatelyWomenPredominatelyMenEtiologyHypertensionCoronaryArteryDiseaseLVSystolicFunctionNormalorPreservedImpairedComorbiditiesMultipleFewComparedwithyoungerHFpatients,HFismor
3、ecommoninolderadultsandaffectedindividualsaremorelikelytobewomen,andtohaveantecedenthypertension,lesscoronaryarterydiseaseandmultiplecomorbidconditions病理生理改变心输出量明显降低：增龄所致的心脏退行性改变，可使心输出量减少，因而老年人轻度心衰就有心输出量明显减少，重度心衰则极度减少。较易发生低氧血症：老年患者由于增龄性呼吸功能减退、低心输出量、肺瘀血、肺通气/血流异常等原因容易出现低氧血症，
4、即使轻度心衰也可有明显的低氧血症。对负荷的心率反应低下：老年人因窦房结等传导组织的退行性变，心衰时心率可以不增快，即使在运动和发热等负荷情况下，心率增快也不明显。心衰的病因冠状动脉病变心肌梗死心肌缺血心室负荷过重压力负荷过重：主动脉和肺动脉狭窄，体循环和肺循环高血压容量负荷过重：瓣膜性心脏病，甲状腺功能亢进心肌疾病肥厚型心肌病淀粉样变性心肌病限制性心肌病充血性心肌病机械性舒张受限性疾病二尖瓣狭窄缩窄性心包炎高排性心衰甲状腺功能亢进慢性贫血动静脉畸形肝硬化维生素B1缺乏RiskFactorsfortheDevelopmentofHFImpor
5、tantmodifiableriskfactorsforthedevelopmentofHFsystolichypertension,ischemicheartdisease,diabetes,leftventricularhypertrophyandvalvularheartdiseaseamongothers(obesity,COPDandatrialfibrillation).Amongthese,systolichypertensionhasthegreatestpopulationattributablerisk,especial
6、lyamongwomen,forthedevelopmentofHF,andisthemostmodifiable主要诱因感染（尤其是呼吸道感染多见）急性心肌缺血快速心律失常（快速房颤、阵发性室上性心动过速）抑制心肌药物输血、输液、劳累、激动、高血压、肾衰及肺栓塞等，肺栓塞诱发心衰在老年人中相对常见。新发心衰的老年患者还应考虑是否存在甲状腺功能减退或亢进。AtypicalSymptomsMalaise,Confusion,Irritability,Anorexia,SleepDisturbance,DecreasedActivity,Abd
7、ominalComplaintsAlternativeExplanationsforSymptomsFluidRetention:Drugs(NSAIDS),VenousInsufficiencyDyspnea:COPD,Anemia,PneumoniaFatigue:Anemia,Hypothyroidism,Obesity,Deconditioning,DepressionMinimizeSymptoms“Ijustcan’tgetaround,I’m87”FewerExertionalSymptomsOsteoarthritis,Sa
8、rcopenia,LossofBalance,PoorVisionChallengesintheClinicalHistoryofHFinOlderAdultsThediagno
