复旦大学临床医学专业：《内科学》课程教学资源（PPT课件讲稿）心力衰竭（范维琥）

Heart failure

1 Heart failure

DEFINITION HEART FAILURE the pathophysiological state in which the heart is unable to pump blood at a rate commensurate with the requirement of the metabolizing tissues or can do so only from an elevated filling pressure. Usually caused by a defect in myocardial contraction(myocardial failure

2 DEFINITION • HEART FAILURE – the pathophysiological state in which the heart is unable to pump blood at a rate commensurate with the requirement of the metabolizing tissues or can do so only from an elevated filling pressure. – Usually caused by a defect in myocardial contraction (myocardial failure)

DEFINITION CONGESTIVE HEART FAILURE Clinical manifested as Pulmonary congestion Systemic congestion Inadequate tissure blood perfusion HEMODYNAMICALLY heart failure (cardiac dysfunction) is diagnosed when LVEDP>18mmHg or RVEDP>10mmHg

3 DEFINITION • CONGESTIVE HEART FAILURE – Clinical manifested as • Pulmonary congestion • Systemic congestion • Inadequate tissure blood perfusion • HEMODYNAMICALLY heart failure (cardiac dysfunction) is diagnosed when – LVEDP>18mmHg or – RVEDP>10mmHg

UNDERLYING CAUSES Primary myocardial dysfunction(systolic and/or diastolic) Cardiomyopathy Primary or secondary metabolic disturbances of myocardium Overloading of heart Pressure overloading Ⅴ olume overloading limited diastolic function

4 UNDERLYING CAUSES • Primary myocardial dysfunction (systolic and/or diastolic) – Cardiomyopathy – Primary or secondary metabolic disturbances of myocardium • Overloading of heart – Pressure overloading – Volume overloading – limited diastolic function

UNDERLYING CAUSES Age 70.3±10.1yr Causes CHD 658% Hypertension 36.0%0 Dila Cardiomy. 11.9% with2°DM14.9% Shanghai oPD. Chin J Cardio/ 2001: 29: 644

5 UNDERLYING CAUSES Age 70.3±10.1 yr. Causes CHD 65.8% Hypertension 36.0% Dila. Cardiomy. 11.9% With 2°DM 14.9% Shanghai OPD, Chin J Cardiol 2001;29:644

Precipitating factors infection arrhythmias Pulmonary embolism overfatigue Pregnancy and delivery Anemia and hemorrhage others

6 Precipitating factors • infection • arrhythmias • Pulmonary embolism • overfatigue • Pregnancy and delivery • Anemia and hemorrhage • others

Pathophysiology Frank-Starling mechanism Activation of neurohormonal pathway(sas and ras) Myocardial damage and remodeling Diasatolic heart failure

7 Pathophysiology • Frank-Starling mechanism • Activation of neurohormonal pathway (SAS and RAS) • Myocardial damage and remodeling • Diasatolic heart failure

LV Remodeling Post MI Acute infarction h。urs) Infarct expansion (hours to days) Global remodeling (days to months)

8

CLINICAL CLASSIFICATION A cute vs. chronic heart failure Right-sided vs left-sided heart failure Low-output vs high-output heart failure Systolic vs diastolic heart failure Asymptomatic vs congestive heart failure

9 CLINICAL CLASSIFICATION • A cute vs. chronic heart failure • Right-sided vs. left-sided Heart failure • Low-output vs high-output heart failure • Systolic vs diastolic heart failure • Asymptomatic vs congestive heart failure

Chronic left-sided HF: symptoms Respiratory distress ■ Exertional dyspnea Paroxysmal nocturnal dyspnea Orthopnea Acute pumonary edema Cough(nonproductive), and hemoptysis Reduced exercise capacity ■ Fatigue and wea kness Urinary symptoms

10 Chronic left-sided HF ：symptoms Respiratory distress Exertional dyspnea Paroxysmal nocturnal dyspnea Orthopnea Acute pumnonary edema Cough (nonproductive), and hemoptysis Reduced exercise capacity Fatigue and weakness Urinary symptoms