《药理学》课程PPT教学课件（Cardiovascular Sys）27 treatment for CHF2

Treatment of congestive heart failure

Treatment of congestive heart failure

Congestive heart failure (CHF) occurs whenthe cardiac output is inadequate to provide theneeds of the body. Patients with CHF developprogressively severe symptom of fatigue, dyspnea,chest pain, syncope, and death. Myocardialinfarction, viral infection, valvular disease, alcoholand so on

Congestive heart failure (CHF) occurs when the cardiac output is inadequate to provide the needs of the body. Patients with CHF develop progressively severe symptom of fatigue, dyspnea, chest pain, syncope, and death. Myocardial infarction, viral infection, valvular disease, alcohol and so on

CHFChronic CHF may be defined an individual expelsless than 40%of the blood from the left ventricle perheartbeat (ejection fraction< 40%)AnormalheartAnormal individual expels about 55to65%of bloodfrom the left ventricle per heartbeat (EF=55~65%)Whyisbasethe40%EF?Because clinical findings demonstrating progressivedeterioration and early mortality in individuals whohaveanEFbelow40%

CHF Chronic CHF may be defined an individual expels less than 40% of the blood from the left ventricle per heartbeat (ejection fraction< 40%) A normal heart A normal individual expels about 55 to 65% of blood from the left ventricle per heartbeat (EF=55~65%) Why is base the 40% EF? Because clinical findings demonstrating progressive deterioration and early mortality in individuals who have an EF below 40%

direct cause of CHF isthought to be due towithdefectiveexcitation-contractioncoupling,andsystolicdiastolicventricularprogressivedysfunction or by an increased workload imposedon the heart.CHF is accompanied by abnormal increases inblood volume and interstitial fluid. The heart, veinsand capillaries are therefore generally dilated withblood. hence the term “congestive " heart failure

direct cause of CHF is thought to be due to defective excitation-contraction coupling, with progressive systolic and diastolic ventricular dysfunction or by an increased workload imposed on the heart. CHF is accompanied by abnormal increases in blood volume and interstitial fluid. The heart, veins, and capillaries are therefore generally dilated with blood. hence the term “congestive ” heart failure

Causes and Symptoms of acute and chronicheart failureCauses and symptoms of acute and chronic heart failuresymptomscausesAcute HFChronic HFAcute HFChronic HFPrimaryToxic drugTachycardiaArrhythmiashypertensionexposureedemaHypertensionMyocardialCoronaryinfarctionarterydiseaseShortnessofedemaMyocardialbreathischemiacardiomegalyCardiacvalveReducedexercisediseasetolerance

Causes and Symptoms of acute and chronic heart failure Causes and symptoms of acute and chronic heart failure causes symptoms Acute HF Chronic HF Acute HF Chronic HF Toxic drug exposure Coronary artery disease Primary hypertension Myocardial infarction Myocardial ischemia Cardiac valve disease Tachycardia edema Shortness of breath Reduced exercise tolerance Arrhythmias Hypertension edema cardiomegaly

Characteristics of left and right heart failureCharacteristics of left andright heart failureLeft HF:Right HF:Forward failureBackward failureReduced cardiacoutputReduced cardiac outputHypotensionHypotensionPulmonary edemaPeripheral edemaDyspneaHepatomegalyFatigueAscites

Characteristics of left and right heart failure Characteristics of left and right heart failure Left HF: Forward failure Right HF: Backward failure Reduced cardiac output Hypotension Pulmonary edema Dyspnea Fatigue Reduced cardiac output Hypotension Peripheral edema Hepatomegaly Ascites

Aconsiderable body of literature supportsabnormalities in myocardial excitation-contractioncoupling in CHF.An appreciation of the principlesinvolved in this cell signaling process is crucial tounderstand current and future pharmacotherapiesfor CHF.A brief overview of myocardialexcitation-contraction coupling will be provided

A considerable body of literature supports abnormalities in myocardial excitation–contraction coupling in CHF. An appreciation of the principles involved in this cell signaling process is crucial to understand current and future pharmacotherapies for CHF. A brief overview of myocardial excitation–contraction coupling will be provided

Physiology of muscle contractionA. Action potentialcardiac muscle cells are electrically excitable.However unlike the cells of othermusclesand nerves, the cells of cardiac muscle showa spontaneous, intrinsic rhythm generatedby specialized “pacemaker" cells located inthe sinoatrial (SA),and atrioventricular (AV)nodes.The cardiac cells also have anunusually long action potentialB.Cardiac contraction

Physiology of muscle contraction A. Action potential cardiac muscle cells are electrically excitable. However unlike the cells of other muscles and nerves, the cells of cardiac muscle show a spontaneous, intrinsic rhythm generated by specialized “pacemaker” cells located in the sinoatrial (SA), and atrioventricular (AV) nodes. The cardiac cells also have an unusually long action potential. B. Cardiac contraction

myocardial excitation-contraction couplingThe physiological processes that beginwithcardiac sarcolemma membrane depolarization andculminate in contraction are collectively defined asmyocardial excitation-contraction coupling

myocardial excitation–contraction coupling The physiological processes that begin with cardiac sarcolemma membrane depolarization and culminate in contraction are collectively defined as myocardial excitation–contraction coupling

Cardiac contractilityMyocardial contraction is the result ofcalcium entry through L-type channels, givingrise to an increase in cytosolic calciumThe calcium is derived from two sources:1.Extracellular calcium2. The sarcoplasmic reticulum andmitochondria

Cardiac contractility Myocardial contraction is the result of calcium entry through L-type channels, giving rise to an increase in cytosolic calcium The calcium is derived from two sources: 1. Extracellular calcium 2. The sarcoplasmic reticulum and mitochondria