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1、CHRONICCONGESTIVEHEARTFAILUREDr.GaoWeiDept.ofCardiologyFirstHospital,PekingUniversityJune,1999DEFINITION“ThesituationwhentheheartisincapableofmaintainingacardiacoutputadequatetoAccommodatemetabolicrequirementsandthevenousreturn.”E.BraunwaldHeartfailureisacomp
2、lexclinicalsyndromethatcanresultfromanystructuralorfunctionalcardiacdisorderthatimpairstheabilityoftheventricletofillwithorejectblood.ThecardinalmanifestationsofHFaredyspneaandfatigue,whichmaylimitexercisetolerance,andfluidretention,whichmayleadtopulmonarycon
3、gestionandperipheraledema.CHFguideline,2001CHFNearly5millionptsinUShaveHF,andnearly500,000ptsarediagnosedwithHFforthefirsttimeeachyear.Duringthelast10yearstheannualnumberofhospitalizationshasincreasedfromapproximately550,000tonearly900,000forHFasaprimarydiagn
4、osisandfrom1.7to2.6millionforHFasaprimaryorsecondarydiagnosisNearly300,000ptsdieofHFasaprimaryorcontributorycauseeachyear,andthenumberofdeathshasincreasedsteadilydespiteadvancesintreatment.Approximately6%to10%ofpeopleolderthan65yearshaveHF,andapproximately80%
5、ofptshospitalizedwithHFaremorethan65yearsold.CardiacfunctionclassificationNewYorkHeartAssociation(NYHA)ClassI:Patientswithcardiacdiseasebutwithoutresultinglimitationsofphysicalactivity.ClassII:Patientswithcardiacdiseaseresultinginslightlimitationofphysicalact
6、ivity.Theyarecomfortableatrest.Ordinaryphysicalactivityresultinfatigue,palpitation,dyspneaoranginalpain.CardiacfunctionclassificationNewYorkHeartAssociation(NYHA)ClassIII:Patientswithcardiacdiseaseresultinginmarkedlimitationofphysicalactivity.Theyarecomfortab
7、leatrest.Lessthanordinaryphysicalactivityresultinfatigue,palpitation,dyspneaoranginalpain.ClassIV:Patientswithcardiacdiseaseresultingininabilitytocarryonanyphysicalactivitywithoutdiscomfort.EVOLUTIONOFCLINICALSTAGESNORMALAsymptomaticLVDysfunctionCompensatedCH
8、FDecompensatedCHFNosymptomsNormalexerciseNormalLVfxnNosymptomsNormalexerciseAbnormalLVfxnNosymptomsExerciseAbnormalLVfxnSymptomsExerciseAbnormalLVfxnRefractoryCHFSymptomsnotcontrolledwith
