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Heartfailure
11
DEFINITIONHEARTFAILUREAclinicalsyndromeinwhichanabnormalityofcardiacstructureorfunctionisresponsiblefortheinabilityofthehearttoejectorfillwithbloodataratecommensuratewiththerequirementsofthemetabolizingtissues.Heartfailureresultsinaconstellationofclinicalmanifestations,includingcirculatorycongestion,dyspnea,fatigue,andweakness.2 DEFINITIONHEARTFAILURE2FORMSOFHEARTFAILURESystolicvsdiastolicheartfailureLow-outputvshigh-outputheartfailureAcutevschronicheartfailureRight-sidedvsleft-sidedheartfailure3FORMSOFHEARTFAILURESystolicUNDERLYINGCAUSES
IschemicheartdiseaseCardiomyopathiesCongenital,valvularandhypertensiveheartdisease(potentialtreatable)4UNDERLYINGCAUSESIschemicheaPRECIPITATINGFACTORS
InfectionArrhythmiasPhysical,dietary,fluid,environmental,andemotionalexcessesMyocardialinfarctionPulmonaryembolismAnemiaThyrotoxicosisandpregnancyAggravationofhypertensionRheumatic,viral,andotherformsofmyocarditisInfectiveendocarditis5PRECIPITATINGFACTORSInfectioPATHOGENESISChronichemodynamicoverload→eccentricventricularhypertrophyChronicpressureoverload→concentricventricularhypertrophyVentr.hypertrophy→ventr.DilatationRemodelingofventricle→HFActivationofendogenousneurohormonalsystemandcytokines6PATHOGENESISChronichemodynami
“7“7
CLINICALMANIFESTATIONOFHF
Primary
SymptomsDyspneaOrthopneaParoxysmal(nocturnal)dyspneaAcutepumnonaryedema8CLINICALMANIFESTATIONOFHFCLINICALMANIFESTATIONOFHFOthersymptomsFatigueandweaknessAbdominalsymptomsCerebralsymptoms9CLINICALMANIFESTATIONOFHFOtPHYSICALFINDINGSOFHFGeneralfindings↓Pulsepressure（severeHF)↓SBPwithcool,diaphoreticextremities,andCheyne-StokesrespirationCyanosis,sinustachycardia10PHYSICALFINDINGSOFHFGeneralPHYSICALFINDINGSOFHFCardiovascularfindingsS3and
S4CardiomegalyMurmursPulsusalternansDistentionofjv.(↑systemicv.p)11PHYSICALFINDINGSOFHFCardioPHYSICALFINDINGSOFHFPulmonaryralesCardiacedemaSymmetricanddependentinthelegsMostprominetineveningHydrothoraxandascitesCongestivehepatomegaly.12PHYSICALFINDINGSOFHFPulmonaLABORATORYEXAMINATIONN-terminal-pro-BNPandBNPTwo-dimensioanlechocardiographywithDopplerflowstudiesChestroentgenogramECG13LABORATORYEXAMINATIONN-terminEchocardiogram
2DechowithDoplertechniqueforsystolicanddiastolicfunctionofLVLVDdandLVDs（DdandDs）LVEF14Echocardiogram2DechowithDoDIAGNOSISOFHFCombinationoftheclinicalmanifestationofHF,togetherwiththefindingscharacteristicofoneoftheunderlyingformsofheartdisease.15DIAGNOSISOFHFCombinationofDIFF.DIAGNOSISOFHFPulmonarydiseasePulmonaryembolismAnkleedemaEnlargementoftheliverandascites16DIFF.DIAGNOSISOFHFPulmonarTREATMENTOFHFCorrectionoftheunderlyingcauseRemovaloftheprecipitatingcausePreventionofdeteriorationofcardiacfunctionControlofthecongestiveHFstate17TREATMENTOFHFCorrectionoft
GENERALMEASURES
TreatingcoronaryriskfactorsModeratedietaryNarestrictionDailymeasurementofweightPreventrespiratoryinfectionAviodingexcessivealcohol,temperatureextremes,andtiringtripsGENERALMEASURESTreatingcoTREATMENTOFHFControlofexcessivefluidDietDiureticsThiazidediureticsMetolazoneFrusemideBumetanidetorsemidePotassium-sparingdiuretics19TREATMENTOFHFControlofexceTREATMENTOFHFBlockadeofrenin-angiotensin-aldosteroneandadrenergicsystemACEinhibitorsAngiotensinreceptorblockersBeta-adrenoceptorblockersAldosteroneantagonist20TREATMENTOFHFBlockadeofrenTREATMENTOFHFEnhancementofmyocardialcontractilityDigitalisSympathomimeticaminesPhosphodiesteraseinhibitors21TREATMENTOFHFEnhancementofTREATMENTOFHFVasodilatorsNitratesNitroglycerineIsosorbidedinitrateMononitratesNitroprussidenesiritide22TREATMENTOFHFVasodilators22TREATMENTOFHFVentricularresynchronizationManagementofarrhythmiaAnticoagulantsRefractoryheartHFAssistedcirculation/cardiactransplant.23TREATMENTOFHFVentricularresSTAGEAAthighriskforHFbutwithoutstructuralheartdiseaseorsymptomsofHF.TreathypertensionEncouragesmokingcessationTreatlipiddisordersEncourageregularexerciseDiscouragealcoholintake,illicitdruguseControlmetabolicsyndromeACEIorARBinappropriatepatientsforvasculardiseaseordiabetes24STAGEAAthighriskforHFbutSTAGEBStructuralheartdiseasebutwithoutsignsorsymptomsofHFAllmeasuresunderStageAACEIorARBinappropriatepatientsBeta-blockersinappropriatepatients25STAGEBStructuralheartdiseasSTAGECStructuralheartdiseasewithpriororcurrentsymptomsofHF.AllmeasuresunderStagesAandBDietarysaltrestrictionDRUGSFORROUTINEUSEDiureticsforfluidretentionACEIBeta-blockersDRUGSINSELECTEDPATIENTSAldosteroneantagonistARBsDigitalisHydralazine/nitratesDEVICESINSELECTEDPATIENTSBiventricularpacingImplantabledefibrillators26STAGEC26STAGEDRefractoryHFrequiringspecializedinterventions.AppropriatemeasuresunderStagesA,B,CDecisionre:appropriatelevelofcareOPTIONSCompassionateend–of-lifecare/hospiceExtraordinarymeasureshearttransplantchronicinotropespermanentmechanicalsupportexperimentalsurgeryordrugs27STAGEDRefractoryHFrequiringPROGNOSISOFHFDependonNatureoftheunderlyingheartdiseasePresenceofatreatableprecipitatingfactorTheresponsetotreatment28PROGNOSISOFHFDependon28谢谢29谢谢29docin/sanshengshiyuandoc88/sanshenglu
更多精品资源请访问docin/sanshengshiyuan更多精品Heartfailure
311
DEFINITIONHEARTFAILUREAclinicalsyndromeinwhichanabnormalityofcardiacstructureorfunctionisresponsiblefortheinabilityofthehearttoejectorfillwithbloodataratecommensuratewiththerequirementsofthemetabolizingtissues.Heartfailureresultsinaconstellationofclinicalmanifestations,includingcirculatorycongestion,dyspnea,fatigue,andweakness.32 DEFINITIONHEARTFAILURE2FORMSOFHEARTFAILURESystolicvsdiastolicheartfailureLow-outputvshigh-outputheartfailureAcutevschronicheartfailureRight-sidedvsleft-sidedheartfailure33FORMSOFHEARTFAILURESystolicUNDERLYINGCAUSES
IschemicheartdiseaseCardiomyopathiesCongenital,valvularandhypertensiveheartdisease(potentialtreatable)34UNDERLYINGCAUSESIschemicheaPRECIPITATINGFACTORS
InfectionArrhythmiasPhysical,dietary,fluid,environmental,andemotionalexcessesMyocardialinfarctionPulmonaryembolismAnemiaThyrotoxicosisandpregnancyAggravationofhypertensionRheumatic,viral,andotherformsofmyocarditisInfectiveendocarditis35PRECIPITATINGFACTORSInfectioPATHOGENESISChronichemodynamicoverload→eccentricventricularhypertrophyChronicpressureoverload→concentricventricularhypertrophyVentr.hypertrophy→ventr.DilatationRemodelingofventricle→HFActivationofendogenousneurohormonalsystemandcytokines36PATHOGENESISChronichemodynami
“37“7
CLINICALMANIFESTATIONOFHF
Primary
SymptomsDyspneaOrthopneaParoxysmal(nocturnal)dyspneaAcutepumnonaryedema38CLINICALMANIFESTATIONOFHFCLINICALMANIFESTATIONOFHFOthersymptomsFatigueandweaknessAbdominalsymptomsCerebralsymptoms39CLINICALMANIFESTATIONOFHFOtPHYSICALFINDINGSOFHFGeneralfindings↓Pulsepressure（severeHF)↓SBPwithcool,diaphoreticextremities,andCheyne-StokesrespirationCyanosis,sinustachycardia40PHYSICALFINDINGSOFHFGeneralPHYSICALFINDINGSOFHFCardiovascularfindingsS3and
S4CardiomegalyMurmursPulsusalternansDistentionofjv.(↑systemicv.p)41PHYSICALFINDINGSOFHFCardioPHYSICALFINDINGSOFHFPulmonaryralesCardiacedemaSymmetricanddependentinthelegsMostprominetineveningHydrothoraxandascitesCongestivehepatomegaly.42PHYSICALFINDINGSOFHFPulmonaLABORATORYEXAMINATIONN-terminal-pro-BNPandBNPTwo-dimensioanlechocardiographywithDopplerflowstudiesChestroentgenogramECG43LABORATORYEXAMINATIONN-terminEchocardiogram
2DechowithDoplertechniqueforsystolicanddiastolicfunctionofLVLVDdandLVDs（DdandDs）LVEF44Echocardiogram2DechowithDoDIAGNOSISOFHFCombinationoftheclinicalmanifestationofHF,togetherwiththefindingscharacteristicofoneoftheunderlyingformsofheartdisease.45DIAGNOSISOFHFCombinationofDIFF.DIAGNOSISOFHFPulmonarydiseasePulmonaryembolismAnkleedemaEnlargementoftheliverandascites46DIFF.DIAGNOSISOFHFPulmonarTREATMENTOFHFCorrectionoftheunderlyingcauseRemovaloftheprecipitatingcausePreventionofdeteriorationofcardiacfunctionControlofthecongestiveHFstate47TREATMENTOFHFCorrectionoft
GENERALMEASURES
TreatingcoronaryriskfactorsModeratedietaryNarestrictionDailymeasurementofweightPreventrespiratoryinfectionAviodingexcessivealcohol,temperatureextremes,andtiringtripsGENERALMEASURESTreatingcoTREATMENTOFHFControlofexcessivefluidDietDiureticsThiazidediureticsMetolazoneFrusemideBumetanidetorsemidePotassium-sparingdiuretics49TREATMENTOFHFControlofexceTREATMENTOFHFBlockadeofrenin-angiotensin-aldosteroneandadrenergicsystemACEinhibitorsAngiotensinreceptorblockersBeta-adrenoceptorblockersAldosteroneantagonist50TREATMENTOFHFBlockadeofrenTREATMENTOFHFEnhancementofmyocardialcontractilityDigitalisSympathomimeticaminesPhosphodiesteraseinhibitors51TREATMENTOFHFEnhancementofTREATMENTOFHFVasodilatorsNitratesNitroglycerineIsosorbidedinitrateMononitratesNitroprussidenesiritide52TREATMENTOFHFVasodilators22TREATMENTOFHFVentricularresynchronizationManagementofarrhythmiaAnticoagulantsRefractoryheartHFAssistedcirculation/cardiactransplant.53TREATMENTOFHFVentricularresSTAGEAAthighriskforHFbutwithoutstructuralheartdiseaseorsymptomsofHF.TreathypertensionEncouragesmokingcessationTreatlipiddisordersEncourageregularexerciseDiscouragealcoholintake,illicitdruguseControlmetabolicsyndromeACEIorARBinappropriatepatientsforvasculardiseaseordiabetes54STAGEAAthighriskforHFbutSTAGEBStructuralheartdiseas
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