心力衰竭——英文版
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Heart failure may develop as a result of impaired myocardial contraction .
Diastolic dysfunction
Heart failure can also be due to poor ventricular filling pressure caused by abnormal ventricular relaxation ,which is commonly found in patients with left ventricular hypertrophy, hypertension and ischemic heart disease.
Objective :
1.Mastering clinical manifestation ,diagnosis and management of heart failure
2.Grasping causes,pathophysiology of heart failure
3.Understanding classification and investigation of heart failure
Low output heart failure:
Clinical manifestation of abnormal peripheral circulation: vasoconstriction in system , cold, pale, extremities cyanosis, in the late period,output per minute decrease and lead to difference of pulse pressure decrease, the above manifestation occur in the majority of CHF.
1)clinical manifestation 2)investigation 3)diagnosis and differential diagnosis 4)management
Definition
Heart failure is an imprecise term used to describe the state that develops when the heart cannot maintain an adequate cardiac output or can do so only at the expense of an elevated filling pressure.
Precipitating / aggravating factors
• myocardial ischemia or infarction • infection • arrhythmia • pulmonary embolism • exertion • pregnancy and parturition • anemia • intravenous fluid overload, electrolyte
pulmonary edema pulmonary compliance
Clinical Features
• pulmonary congestion, • systemic venous congestion , • tissue perfusion deficiency due to
low cardiac output .
Hemodynamic Features
Type of heart failure . Heart failure can be described or classified in several ways
• 1. Acute and chronic heart failure • 2. Left ,right and biventricular heart failure • 3. High and low output heart failure • 4. Diastolic and systolic dysfunction • 5.Asymptomatic and congestive heart failure
initial myocardium impaired ventricular overload myocardium infarction inflammation
disease progress heart failure complication death
chamber enlargement myocardial hypertrophy embryo gene phenotype extracellular matrix change
神经体液兴奋 RAS SAS
↓心肌松弛性
↑胞浆Ca2+ cAMP InSP3
↑变力效应2–2 肾素—血管紧张素和交感—肾 上腺素能系统激活时对心脏代偿功能的影响
• 2. RAAS in Heart Failure
• 3.myocardium impaired and remodeling
图3–2–4 心室舒张末期压力和容积的关系 舒张性心力衰竭时，心室顺应性降低，心室压力–容积曲线 向左上方移位，即在任何特定的舒张末期压时，心室末期 容量小于正常人。
a. sarcoplasmic reticulum intake Ca2+ free Ca2+ in myocyte degrade slowly
1.Reduced ventricular contractility a. Cardiomyopathy, myocardial infarction. b. Metabolic dysfunction
2.ventricular overload
a. pressure overload---- hypertension , aortic stenosis, pulmonary hypertension, pulmonary valve stenosis.
b.Preload: the volume and pressure of blood in the ventricle at the end of diastole.
c. Afterload :the arterial resistance.
最大活 动
左 室 作 功 活动
静息
C 2 正常活动
1 正常静息 心肌收缩性
High output heart failure:
Extremities warm,flush, difference of pulse pressure increase, seen in hyperthyroidism,anemia,pregnancy
Systolic dysfunction
relaxation dysfunction
b. In CHD with obvious ischemia ,before contractility dysfunction, have occurred relaxation dysfunction
c. In hypertrophy and hypertrophic cardiomyopathy, left ventricular end-diastolic filling pressure pulmonary hypertension ,pulmonary congestion diastolic heart failure
disturbance, acid-base imbalance
Pathophysiology
• 1. Frank-Starling’s Law of the heart a. The cardiac output is a function of the
preload, the afterload, and myocardial contractility.
b. volume overload ---- mitral regurgitation, aortic regurgitation , atrial septal defect, ventricular sepals defect , hyperthyroidism, artery-venous fistula.
Heart failure may develop as a result of poor ventricular filling and high filling pressure caused by abnormal ventricular relaxation
压
力
顺应性 ↓
正常
顺应性 ↑
容积
3)Orthopnea: in decubitus,blood volume flow
to heart increase
elevated end–diastolic
filling pressure
pulmonary venous and
capillary pressure increase
interstitial
§1 Chronic heart failure
Definition same meaning as congestive heart failure
clinical manifestation
1.left ventricular heart failure
mainly manifested with pulmonary congestion and reduction of cardiac output A symptom 1.dyspnea 1)breathlessness 2) paroxysmal nocturnal dyspnea:often with wheeze sound in both lung cardiogenic asthma
B AD
3’ 心衰活动 3 心衰静息
E
4 静息
致死性心肌受损
呼吸困 左室难舒张末容量
肺水肿
图3–2–1 正常和心力衰竭时对机体活动时的代偿 情况
2. RAAS in Heart Failure
+ 心肌细胞死亡
心力衰竭
+ 心肌细胞死亡
↑心肌能量消耗
— ↑后负荷
血管收缩
InSP3
↓心排血量
↑心肌能量消耗 + －
Content
1.general concept
1)causes of heart failure 2)precipitating/aggravating factors 3)pathophysiology 4)type of heart failure
2.chronic and acute heart failure
left ventricular end-diastolic pressure>18mmHg, right ventricular end-diastolic pressure>10mmHg,
heart failure = cardiac insuffiency.
Causes of heart failure
•secondary conduct factor •sympathetic nervous system •RAAS •endothelins •TNF-α ,IL-6 •mechanical stress •oxidative stress
• 4.Diastolic heart failure
c. ventricular inflow obstruction----hypertrophy , mitral stenosis, tricuspid stenosis, restrictive cardiomyopathy, constrictive pericarditis .endocardial fibrosis and other disorders that cause a stiff myocardium.
Diastolic dysfunction
Heart failure can also be due to poor ventricular filling pressure caused by abnormal ventricular relaxation ,which is commonly found in patients with left ventricular hypertrophy, hypertension and ischemic heart disease.
Objective :
1.Mastering clinical manifestation ,diagnosis and management of heart failure
2.Grasping causes,pathophysiology of heart failure
3.Understanding classification and investigation of heart failure
Low output heart failure:
Clinical manifestation of abnormal peripheral circulation: vasoconstriction in system , cold, pale, extremities cyanosis, in the late period,output per minute decrease and lead to difference of pulse pressure decrease, the above manifestation occur in the majority of CHF.
1)clinical manifestation 2)investigation 3)diagnosis and differential diagnosis 4)management
Definition
Heart failure is an imprecise term used to describe the state that develops when the heart cannot maintain an adequate cardiac output or can do so only at the expense of an elevated filling pressure.
Precipitating / aggravating factors
• myocardial ischemia or infarction • infection • arrhythmia • pulmonary embolism • exertion • pregnancy and parturition • anemia • intravenous fluid overload, electrolyte
pulmonary edema pulmonary compliance
Clinical Features
• pulmonary congestion, • systemic venous congestion , • tissue perfusion deficiency due to
low cardiac output .
Hemodynamic Features
Type of heart failure . Heart failure can be described or classified in several ways
• 1. Acute and chronic heart failure • 2. Left ,right and biventricular heart failure • 3. High and low output heart failure • 4. Diastolic and systolic dysfunction • 5.Asymptomatic and congestive heart failure
initial myocardium impaired ventricular overload myocardium infarction inflammation
disease progress heart failure complication death
chamber enlargement myocardial hypertrophy embryo gene phenotype extracellular matrix change
神经体液兴奋 RAS SAS
↓心肌松弛性
↑胞浆Ca2+ cAMP InSP3
↑变力效应2–2 肾素—血管紧张素和交感—肾 上腺素能系统激活时对心脏代偿功能的影响
• 2. RAAS in Heart Failure
• 3.myocardium impaired and remodeling
图3–2–4 心室舒张末期压力和容积的关系 舒张性心力衰竭时，心室顺应性降低，心室压力–容积曲线 向左上方移位，即在任何特定的舒张末期压时，心室末期 容量小于正常人。
a. sarcoplasmic reticulum intake Ca2+ free Ca2+ in myocyte degrade slowly
1.Reduced ventricular contractility a. Cardiomyopathy, myocardial infarction. b. Metabolic dysfunction
2.ventricular overload
a. pressure overload---- hypertension , aortic stenosis, pulmonary hypertension, pulmonary valve stenosis.
b.Preload: the volume and pressure of blood in the ventricle at the end of diastole.
c. Afterload :the arterial resistance.
最大活 动
左 室 作 功 活动
静息
C 2 正常活动
1 正常静息 心肌收缩性
High output heart failure:
Extremities warm,flush, difference of pulse pressure increase, seen in hyperthyroidism,anemia,pregnancy
Systolic dysfunction
relaxation dysfunction
b. In CHD with obvious ischemia ,before contractility dysfunction, have occurred relaxation dysfunction
c. In hypertrophy and hypertrophic cardiomyopathy, left ventricular end-diastolic filling pressure pulmonary hypertension ,pulmonary congestion diastolic heart failure
disturbance, acid-base imbalance
Pathophysiology
• 1. Frank-Starling’s Law of the heart a. The cardiac output is a function of the
preload, the afterload, and myocardial contractility.
b. volume overload ---- mitral regurgitation, aortic regurgitation , atrial septal defect, ventricular sepals defect , hyperthyroidism, artery-venous fistula.
Heart failure may develop as a result of poor ventricular filling and high filling pressure caused by abnormal ventricular relaxation
压
力
顺应性 ↓
正常
顺应性 ↑
容积
3)Orthopnea: in decubitus,blood volume flow
to heart increase
elevated end–diastolic
filling pressure
pulmonary venous and
capillary pressure increase
interstitial
§1 Chronic heart failure
Definition same meaning as congestive heart failure
clinical manifestation
1.left ventricular heart failure
mainly manifested with pulmonary congestion and reduction of cardiac output A symptom 1.dyspnea 1)breathlessness 2) paroxysmal nocturnal dyspnea:often with wheeze sound in both lung cardiogenic asthma
B AD
3’ 心衰活动 3 心衰静息
E
4 静息
致死性心肌受损
呼吸困 左室难舒张末容量
肺水肿
图3–2–1 正常和心力衰竭时对机体活动时的代偿 情况
2. RAAS in Heart Failure
+ 心肌细胞死亡
心力衰竭
+ 心肌细胞死亡
↑心肌能量消耗
— ↑后负荷
血管收缩
InSP3
↓心排血量
↑心肌能量消耗 + －
Content
1.general concept
1)causes of heart failure 2)precipitating/aggravating factors 3)pathophysiology 4)type of heart failure
2.chronic and acute heart failure
left ventricular end-diastolic pressure>18mmHg, right ventricular end-diastolic pressure>10mmHg,
heart failure = cardiac insuffiency.
Causes of heart failure
•secondary conduct factor •sympathetic nervous system •RAAS •endothelins •TNF-α ,IL-6 •mechanical stress •oxidative stress
• 4.Diastolic heart failure
c. ventricular inflow obstruction----hypertrophy , mitral stenosis, tricuspid stenosis, restrictive cardiomyopathy, constrictive pericarditis .endocardial fibrosis and other disorders that cause a stiff myocardium.