英文班內(nèi)科學(xué)心力衰竭英文班內(nèi)科學(xué)心力衰竭第1頁Heartfailure(HF)

Conception:heartfailureisafinalcommonpathwayformanycardiacdisordersofdiverseetiologyandpathogenicmechanisms.Itisaclinicalsyndrome,manifestedasaresultoftheinabilityofthehearttomatchitsoutputtothemetabolicneedsofthebodyeventhoughthefillingpressureoftheheartisadequate.英文班內(nèi)科學(xué)心力衰竭第2頁CategoriesofHF1.left,rightandwhole2.acuteandchronic3.systolicanddiastolic英文班內(nèi)科學(xué)心力衰竭第3頁stageofHFPre-heartfailurePre-clincalheartfailureClinicalheartfailureRefractoryend-stageheartfailure英文班內(nèi)科學(xué)心力衰竭第4頁NewYorkHeartAssociationFunctionalClassificationClassⅠNolimitationofphysicalactivityNosympotomswithordinaryexertionClassⅡSlightlimitationofphysicalactivity

Ordinaryactivitycausessymptoms

ClassⅢ

Markedlimitationofphysicalactivity

Lessthanordinaryactivitycausessymptoms

Asymptomaticatrest

ClassⅣ

Inabilitytocarryoutanyphysicalactivitywithout

discomfort

Sympotomsatrest英文班內(nèi)科學(xué)心力衰竭第5頁StageandClassofHF心衰分期是NYHA分級(jí)補(bǔ)充，但不能替換

NYHA分級(jí)NYHA分級(jí)–

在詳細(xì)病人可上下變動(dòng)

(對(duì)治療反應(yīng)和/或疾病進(jìn)程不一樣)分期–

隨心臟重構(gòu)加重只能進(jìn)展

英文班內(nèi)科學(xué)心力衰竭第6頁6-minwalkdistance

milddegree：＞450mmoderatedegree：150-450mseveredegree：＜150mEvaluationofchronicHF

cardiacfunction

英文班內(nèi)科學(xué)心力衰竭第7頁Fundamentalcausesprimarymyocardialdiseaseincreasedburdenstotheheart英文班內(nèi)科學(xué)心力衰竭第8頁Fundamentalcauses1.primarydecreasedmyocardialcontractility

coronaryheartdiseasemyocarditis,cardiomyopathymyocardialmetabolicdisorder英文班內(nèi)科學(xué)心力衰竭第9頁Fundamentalcauses2.increasedburdenstotheheart①increasedafterload(pressureload):hypertensionaorticstenosispulmonarystenosispulmonaryhypertension英文班內(nèi)科學(xué)心力衰竭第10頁Fundamentalcauses

2.increasedburdenstotheheart②increasedpreload(volumeload):mitralincompetenceaorticincompetencetricuspidincompetenceatrialseptaldefect(ASD)ventricularseptaldefect(VSD)patentductusarteriosus(PDA)hyperthyroidismanemia

英文班內(nèi)科學(xué)心力衰竭第11頁英文班內(nèi)科學(xué)心力衰竭第12頁P(yáng)recipitatingcausesinfection,especiallyrespiratoryinfectionarrhythmias,AFphysicaloremotionalexcessese.g.pregnancyanddeliveryrapidintravenousinfusion,excessivesalttakingmalpraticeprimarydiseasedeteriorationoranewdiseasehappens英文班內(nèi)科學(xué)心力衰竭第13頁P(yáng)athogenesisandpathophysiology1.Compensateheartfailure2.Ventricularremodeling3.Aboutdiastolicinsufficiency4.Humoralfactorschange英文班內(nèi)科學(xué)心力衰竭第14頁1.CompensateheartfailureFrank-Starlingprincipleneurohumoralactivationmyocardialhypertrophy英文班內(nèi)科學(xué)心力衰竭第15頁1.Compensateheartfailure①cardiacdilatation,bywayoftheFrank-Starlingprinciple,contractileforceincreases.英文班內(nèi)科學(xué)心力衰竭第16頁1正常靜息2正?；顒?dòng)3’心衰活動(dòng)3心衰靜息心肌收縮性BADC左室舒張末容量圖3–2–1正常和心力衰竭時(shí)對(duì)機(jī)體活動(dòng)時(shí)代償情況最大活動(dòng)活動(dòng)靜息左室作功呼吸困難肺水腫E4靜息致死性心肌受損英文班內(nèi)科學(xué)心力衰竭第17頁1.Compensateheartfailure②neurohumoralactivation

a.Increaseinsympatheticnervousactivityb.RAASactivated(renninangiotensionaldosteronesystem)英文班內(nèi)科學(xué)心力衰竭第18頁心力衰竭——神經(jīng)體液代償和失代償交感神經(jīng)激活水、鈉潴留水腫肺瘀血血流動(dòng)力學(xué)異常血管收縮心肌耗氧量增加心肌氧供給降低心肌細(xì)胞功效障礙和壞死心肌重塑功效惡化疾病進(jìn)展血管擔(dān)心素Ⅱ兒茶酚胺毒性作用心肌細(xì)胞凋亡腎素-血管擔(dān)心素系統(tǒng)激活代償失代償心衰癥狀體征加重治療目標(biāo)增強(qiáng)心肌收縮英文班內(nèi)科學(xué)心力衰竭第19頁心肌細(xì)胞死亡心力衰竭心肌細(xì)胞死亡++↑心肌能量消耗↑后負(fù)荷血管收縮↓心排血量神經(jīng)體液興奮RASSASInSP3循環(huán)↑心肌能量消耗↑胞漿Ca2+cAMPInSP3

心臟↓心肌松弛性↑變力效應(yīng)+－—心律失常猝死圖3–2–2腎素—血管擔(dān)心素和交感—腎上腺素能系統(tǒng)激活時(shí)對(duì)心臟代償功效影響2.RAASinHeartFailure英文班內(nèi)科學(xué)心力衰竭第20頁2.RAASinHeartFailure英文班內(nèi)科學(xué)心力衰竭第21頁1.Compensateheartfailure③myocardialhypertrophy

MyocardialcellhypertrophysystolepowerNotincreasednumberMyocardialfibreincreasednumberenergyMyocardialcompliance(順應(yīng)性）英文班內(nèi)科學(xué)心力衰竭第22頁2.Ventricularremodeling

英文班內(nèi)科學(xué)心力衰竭第23頁2.Ventricularremodeling

heartfailureistheresultofventricularremodeling.Reducethemyocardialcellsdecrease

of

the

systolic

functionIncreasedmyocardialfibrosis

decrease

of

theVentricularcompliance

HeartcavityexpansionmyocardialhypertrophyextracellularmatrixcollagenfibersMyocardialcells

Compensatedstage

Decompensatedstage英文班內(nèi)科學(xué)心力衰竭第24頁3.aboutdiastolicinsufficiency①Characteristic:inthesecases,fillingoftheleftorrightventricleisabnormal.②Mechanism:myocardialrelaxationisimpaired.Myocardialcompliancedecreasing.

③outcome:diastolicpressures↑----venousereturn↓---fluidretention,dyspnea,intolerance英文班內(nèi)科學(xué)心力衰竭第25頁4.somecytofactorstakepartinheartfailure

ANP(atrialnatriureticpeptide)BNP(brainnatriureticpeptide)AVP(argininevassopressin)Endothelin(NE,angiotensin)UrinevolumeperipheralvascularsympatheticnervousRAASVentricularremodeling英文班內(nèi)科學(xué)心力衰竭第26頁

Ventricularremodelingneurohumoralactivationheartfailure英文班內(nèi)科學(xué)心力衰竭第27頁Chronicheartfailure,CHF英文班內(nèi)科學(xué)心力衰竭第28頁Clinicalmanifestations1.Leftheartfailurepulmonarycongestionlesscardiacoutput2.Rightheartfailuresystemicvenouscongestion3.Wholeheartfailure英文班內(nèi)科學(xué)心力衰竭第29頁1.Leftheartfailure

1)dyspnea1.exertionaldyspnea2.paroxysmalnocturnaldyspnea3.orthopnea,4.acutepulmonaryedema英文班內(nèi)科學(xué)心力衰竭第30頁1.Leftheartfailure

2)cough,hemoptysis,spitpinksputum3)fatigue,dizziness,palpitation.4)oliguria,renaldysfunction

英文班內(nèi)科學(xué)心力衰竭第31頁sign

1)pulmonarybasalralesbilaterallyorright-side2)enlargedleftheartpulsusalternans,protodiastolicgallopP2increasedPulmonaryedema英文班內(nèi)科學(xué)心力衰竭第32頁

2.Rightheartfailuresymptomabdominaldiscomfortanorexia(厭食)nausea,vomitexertionaldyspnea英文班內(nèi)科學(xué)心力衰竭第33頁

2.Rightheartfailuresignliverenlargedascitesdistentionofjugularveinshepatojugularreflux(+)peripheraledema,mostmarkindependentpartscyanosisprotodiastolicgallop,functionalmurmursoftricuspidandpulmonaryvalve英文班內(nèi)科學(xué)心力衰竭第34頁3.WholeheartfailureLHF＋RHF英文班內(nèi)科學(xué)心力衰竭第35頁laboratoryexamination

BNPandNT-proBNP心室擴(kuò)張心衰張力增大BNP釋放英文班內(nèi)科學(xué)心力衰竭第36頁呼吸困難,虛弱,

運(yùn)動(dòng)受限等癥狀(NT-proBNP)

慢性心衰

轉(zhuǎn)至心臟?？评^續(xù)下一步診療陽性陰性NT-proBNP臨床應(yīng)用流程圖輔助診療心衰輔助判斷進(jìn)展期心衰患者預(yù)后英文班內(nèi)科學(xué)心力衰竭第37頁laboratoryexamination

CnTIbloodroutineexaminationroutineurineexaminationbiochemicalexaminationFT3,FT4,TSH英文班內(nèi)科學(xué)心力衰竭第38頁ECG(electrocardiogram)ischemiaOMIconductionblockarrhysmia英文班內(nèi)科學(xué)心力衰竭第39頁X-rayPulmonarycongestionPleuraleffusionKerlryBRightpulmonaryarterybroadeningPulmonaryhilarbutterflyshape英文班內(nèi)科學(xué)心力衰竭第40頁EchocardiogramLVEF＞50%E/A＞1.2LVEDV/LVESVLVEDD/LVESDventricularwallmotionCardiacmagneticresonance,CMR99MTC-MIBISPECT(radionuclide)Coronaryangiography英文班內(nèi)科學(xué)心力衰竭第41頁CardiacCatheterizationSwan-GanzPCWP＜12mmHgCI＞2.5L/（min.m2）英文班內(nèi)科學(xué)心力衰竭第42頁CardiopulmonaryExerciseTesting(CPET)ChronicstableHFMeasurementofrateofoxygenuptake(VO2),rateofCO2production(VCO2),duringmaximal“symptom-limited”exercise英文班內(nèi)科學(xué)心力衰竭第43頁英文班內(nèi)科學(xué)心力衰竭第44頁DiagnosisanddifferentialdiagnosisDiagnosis:medicalhistory+symptoms+signs+examExam:ECG:rarelynormalinsystolicHF.x-ray:todetectcardiomegalyandpulmonarycongestion.(3)Echocardiogram:Itiscriticalimportance.①todeterminetheunderlyingcausesofHF②toassesstheseverityofventriculardysfunctiona.functionofcontraction:LVEF>50%b.functionofrelaxation:E/A≥1.2

英文班內(nèi)科學(xué)心力衰竭第45頁2.Differentialdiagnosis:cardiacasthmaBronchialasthmaHistoryHeartdiseaseallergichistoryageolderyoungtimenightspringHFsignyesnoLungsignpulmonarybasalralestypicalwheezingx-rayPulmonarycongestionLVlargeemphysemaalleviatesymptomsofdyspneaDiureticsdigitalisisosorbidedinitrateaftercoughoutsputumantispasmodic英文班內(nèi)科學(xué)心力衰竭第46頁2.Differentialdiagnosis:②Pericardialeffusion,Constrictivepericarditis:distentionofjugularveins,hepatojugularreflux(+)liverenlarged,ascitesperipheraledema,mostmarkindependentparts

medicalhistorysignsofheartandperivascularechocardiogram,CMR…themostsensitive…specificnoninvasivemethod英文班內(nèi)科學(xué)心力衰竭第47頁2.Differentialdiagnosis:③Hepatocirrhosiswithascitesandedemaoflowerextremitydistentionofjugularveins(-)hepatojugularreflux(-)英文班內(nèi)科學(xué)心力衰竭第48頁Treatmentofchronicheartfailure

Principle:alleviatesymptoms,improvelifequality.treatmentforprimarydiseaseandprecipitatingcausesAntagonismofneurohumoralactivationinhibitionofprogressiveventricularremodelingreducemortalityandextendlife.英文班內(nèi)科學(xué)心力衰竭第49頁TreatmentofchronicheartfailureGeneralPharmacologictreatmentNon-medicinetreatment英文班內(nèi)科學(xué)心力衰竭第50頁GeneraltreatmentdecreasedburdensincreasedsystolepowerAnti-neurohumoralactivation英文班內(nèi)科學(xué)心力衰竭第51頁GeneraltreatmentdecreasedburdensincreasedsystolepowerAnti-neurohumoralactivation1.LifestylemanagementEducationRegulateweightDietarymanagement:salttake2.Restandaction3.Treatmentforprimarydiseaseandprecipitating

英文班內(nèi)科學(xué)心力衰竭第52頁GeneraltreatmentdecreasedburdensincreasedsystolepowerAnti-neurohumoralactivation1.Rest2.Dietarymanagement:salttake3.Diuretics

furosemidedihydrochlorothiazide(potassium-losing)antistone(potassium-sparing)英文班內(nèi)科學(xué)心力衰竭第53頁Themainpointofdiureticsapplication對(duì)于有癥狀心衰，當(dāng)液體負(fù)荷過重已表現(xiàn)為肺淤血或外周水腫時(shí)，利尿劑是基本治療。應(yīng)用利尿劑可快速改進(jìn)呼吸困難并增加運(yùn)動(dòng)耐量（I類提議，證據(jù)級(jí)別A）尚無大型隨機(jī)對(duì)照試驗(yàn)評(píng)定這類藥品對(duì)癥狀和生存影響。如能耐受，利尿劑一直應(yīng)與ACEI和β-受體阻滯劑一起使用。（I類提議，證據(jù)級(jí)別C）。英文班內(nèi)科學(xué)心力衰竭第54頁

襻利尿劑應(yīng)作為首選。噻嗪類僅適適用于輕度液體潴留、伴高血壓和腎功效正常心衰患者(I類，B級(jí))。利尿劑通常從小劑量開始(氫氯噻嗪25mg/d，呋塞米20mg/d，托塞米10mg/d),逐步加量。一旦病情控制即以最小有效量長久維持。每日體重改變是最可靠檢測利尿劑效果和調(diào)整利尿劑劑量指標(biāo)。長久服用利尿劑應(yīng)嚴(yán)密觀察不良反應(yīng)出現(xiàn)如電解質(zhì)紊亂、癥狀性低血壓，以及腎功效不全，尤其在服用劑量大和聯(lián)適用藥時(shí)（Ⅰ類，B級(jí)）。Themainpointofdiureticsapplication英文班內(nèi)科學(xué)心力衰竭第55頁GeneraltreatmentdecreasedburdensincreasedsystolepowerAnti-neurohumoralactivation1.Rest2.Dietarymanagement:salttake3.Diuretics4.

Vasodilator

sodiumnitroprusside(SNP)nitroglecerinregitine(酚妥拉明))英文班內(nèi)科學(xué)心力衰竭第56頁ThemainpointofVasodilatorapplication直接血管擴(kuò)張劑對(duì)于CHF治療無特殊作用。（Ⅲ類，A級(jí)）血管擴(kuò)張劑可用于不能耐受ACEI或ARBs患者；伴有心絞痛或高血壓可考慮應(yīng)用（Ⅰ類，B級(jí)）禁忌證：血容量不足，低血壓、腎功效衰竭

心臟流出道或瓣膜狹窄患者英文班內(nèi)科學(xué)心力衰竭第57頁GeneraltreatmentdecreasedburdensincreasedsystolepowerAnti-neurohumoralactivation1.Digitalis

（1）effection:Positiveinotropic：

inhibitNa+-K+-ATPenzyme

introcellularNa+、K+Na+-Ca2+exchange

introcellularCa2+myocardialsystolepower

introcellularK+，digitalispoisoning英文班內(nèi)科學(xué)心力衰竭第58頁GeneraltreatmentdecreasedburdensincreasedsystolepowerAnti-neurohumoralactivation1.Digitalis

（1）effection:Positiveinotropic：Electrophysiological

Inhibitcondutionsystem,espiciallyatriventricularjunction.

Improvetheautorhythmictyofatrium,junctionregionandventricle.英文班內(nèi)科學(xué)心力衰竭第59頁GeneraltreatmentdecreasedburdensincreasedsystolepowerAnti-neurohumoralactivation1.Digitalis

（1）effection:Positiveinotropic：ElectrophysiologicalParasympatheticstimulatinganti-sympatheticnerveexciting

英文班內(nèi)科學(xué)心力衰竭第60頁GeneraltreatmentdecreasedburdensincreasedsystolepowerAnti-neurohumoralactivation1.Digitalis

（1）effection:Positiveinotropic：ElectrophysiologicalParasympatheticstimulatingRoleintherenaltubulecellsreducingsodiumreabsorptioninhibitthesecretionofrenin

英文班內(nèi)科學(xué)心力衰竭第61頁GeneraltreatmentdecreasedburdensincreasedsystolepowerAnti-neurohumoralactivation1.Digitalis

（2）application

indication:chroniccongestiveheartfailurecomplicatedbyatrailflutterandfibrillationandarapidventricularrate英文班內(nèi)科學(xué)心力衰竭第62頁GeneraltreatmentdecreasedburdensincreasedsystolepowerAnti-neurohumoralactivation1.Digitalis

（2）application

contraindication:WPWwithAFⅡdegreeAVB,ⅢdegreeAVBsicksinussyndrome(SSS)Hypertrophiccardiomyopathy(HOCM)severemitralstenosis(SMS)acutemyocardiacinfarction(first24h英文班內(nèi)科學(xué)心力衰竭第63頁GeneraltreatmentdecreasedburdensincreasedsystolepowerAnti-neurohumoralactivation1.Digitalis

(3)digitalispoisoningfactors：K+,O2,RFClincalexpression:gastricbowelreaction;arrhythmia;neurologicalandvisualchangeDiagnosis：>2.0ng/ml英文班內(nèi)科學(xué)心力衰竭第64頁ArrhythmiaofdigitalispoisoningVentricularPrematurebeatNonparoxysmalatrioventricularjunctionaltachycardiaAtrialPrematurebeatAtrialfibrillatonAtrioventricularblockST-TchangelikefishhookCharacteristicfeature英文班內(nèi)科學(xué)心力衰竭第65頁GeneraltreatmentdecreasedburdensincreasedsystolepowerAnti-neurohumoralactivation1.Digitalis

Treatmentofdigitalispoisoningdrugwithdrawaltachycadia:supplyK+

,Lidocainivbradicadia：atropiniv,notsuitableforpacemakernotsuitableforisoprenalinedisablecardioerter英文班內(nèi)科學(xué)心力衰竭第66頁GeneraltreatmentdecreasedburdensincreasedsystolepowerAnti-neurohumoralactivation

1、Digitalis2、β-excitantDopamine：NEprecursor2g/kg.min

Dopamine

-R(+)

expandrenalartery2-5g/kg.min

β1

β2-R(+)myocardialcontractility,Vasodilate5-10g/kg.min

α-R(+)BP,HRDobutamine：Dopaminederivatives

2g/kg.min

10g/kg.min

Vasodilate,HR--smalleffects英文班內(nèi)科學(xué)心力衰竭第67頁GeneraltreatmentdecreasedburdensincreasedsystolepowerAnti-neurohumoralactivation

1、Digitalis2、β-excitant3、Phosphodiesteraseinhibitors

1、effect:restrainactivityofphosphodiesterase

，thedegradationofcAMP(-)

cAMPCa2+

channelactivationCa2+

-inflowmyocardialcontractility

英文班內(nèi)科學(xué)心力衰竭第68頁GeneraltreatmentdecreasedburdensincreasedsystolepowerAnti-neurohumoralactivation

1、Digitalis2、β-excitant3、Phosphodiesteraseinhibitors

1、effect:2、indications

：refractoryheartfailureend-stageheartfailure

beforehearttransplantation

英文班內(nèi)科學(xué)心力衰竭第69頁GeneraltreatmentdecreasedburdensincreasedsystolepowerAnti-neurohumoralactivation

1、Digitalis2、β-excitant3、Phosphodiesteraseinhibitors

1、effect:2、indications

：3、drugs：氨力農(nóng)(Amrinone)VD5-10g/kg.min

米力農(nóng)(Milrinone)VD0.5g/kg.min英文班內(nèi)科學(xué)心力衰竭第70頁GeneraltreatmentdecreasedburdensincreasedsystolepowerAnti-neurohumoralactivation

1、Digitalis2、β-excitant3、Phosphodiesteraseinhibitors

1、effect:2、indications

：3、drugs：4、defect

：

side-effect;mortality

英文班內(nèi)科學(xué)心力衰竭第71頁

AII產(chǎn)生是經(jīng)過各種通道血管擔(dān)心素原腎素血管擔(dān)心素I(1-10)

AngII（1-8）ACEAT1AT2血管收縮增殖醛固酮增加血管擴(kuò)張抗增殖Ang1-7Ang1-7受體激活血管擴(kuò)張抗增殖ARB英文班內(nèi)科學(xué)心力衰竭第72頁GeneraltreatmentdecreasedburdensincreasedsystolepowerAnti-neurohumoralactivation

1、RAASinhibitorAngiotensinConvertingEnzymeInhibitors(ACEI)

dilatebloodvessels

inhibitRAS,sympathetic

systemreversetheventricularremodeling

improvearterystiffnessandsensitivity

Improveendothelialfunction

ATⅡ↓,Inhibitthedegradationof

bradykinin英文班內(nèi)科學(xué)心力衰竭第73頁GeneraltreatmentdecreasedburdensincreasedsystolepowerAnti-neurohumoralactivation

1、RAASinhibitorAngiotensinConvertingEnzymeInhibitors(ACEI)

Clinicalstatus

symptoms↓,exercisetolerance

↑

mortality↓

delaytheprogressofheartfailure

reducinghospitalizationrates

preventHFaftermyocardialinfarction

英文班內(nèi)科學(xué)心力衰竭第74頁GeneraltreatmentdecreasedburdensincreasedsystolepowerAnti-neurohumoralactivation

1、RAASinhibitorAngiotensinConvertingEnzymeInhibitors(ACEI)

Captopril6.25～25mg2～3/dEnalapril10mg2/dCilazapril2.5mg/dBenazepril2.5～10mg/dPerindopril2～4mg/dFosinopril5～10mg/dRamipril2.5mg/d英文班內(nèi)科學(xué)心力衰竭第75頁GeneraltreatmentdecreasedburdensincreasedsystolepowerAnti-neurohumoralactivation

1、RAASinhibitorAngiotensinConvertingEnzymeInhibitors(ACEI)

applicationmethods

startingwithsmalldosesiftolerated,gradually

increasethedosemonitoringofrenalfunctionandions

renalfunctionchange,highpotassium,drycough,angioedema

英文班內(nèi)科學(xué)心力衰竭第76頁GeneraltreatmentdecreasedburdensincreasedsystolepowerAnti-neurohumoralactivation

1、RAASinhibitorAngiotensinConvertingEnzymeInhibitors(ACEI)

Contraindication:

①anuricrenalfailure

②pregnancyandbrestfeedingwoman

③allergeRelativeContraindication:①renalarterystenosisbilaterally②Cr>225μmol/l③k+>5.5mmol/l④hypotension英文班內(nèi)科學(xué)心力衰竭第77頁GeneraltreatmentdecreasedburdensincreasedsystolepowerAnti-neurohumoralactivation

1、RAASinhibitorAngiotensinConvertingEnzymeInhibitors(ACEI)AngiotensinIIreceptorantagonist(ARB)ATⅡ-AT1receptor↓InhibitRASNoaffectingthedegradationof

bradykinin英文班內(nèi)科學(xué)心力衰竭第78頁GeneraltreatmentdecreasedburdensincreasedsystolepowerAnti-neurohumoralactivation

1、RAASinhibitorAngiotensinConvertingEnzymeInhibitors(ACEI)AngiotensinIIreceptorantagonist(ARB)applicationmethods

lessdrycoughandangioedema

whenHF,firstchoseACEIwhenHF,shouldnotbecombinedapplication

of

ACEIandARB

Losartan50mg/d;valsartan80mg/d英文班內(nèi)科學(xué)心力衰竭第79頁GeneraltreatmentdecreasedburdensincreasedsystolepowerAnti-neurohumoralactivation

1、RAASinhibitorAngiotensinConvertingEnzymeInhibitors(ACEI)AngiotensinIIreceptorantagonist(ARB)Aldosterone

antagonists

spironolactone(SPI)potassium-sparingdiureticreversetheventricularremodeling

improveprognosis英文班內(nèi)科學(xué)心力衰竭第80頁GeneraltreatmentdecreasedburdensincreasedsystolepowerAnti-neurohumoralactivation

1、RAASinhibitorAngiotensinConvertingEnzymeInhibitors(ACEI)AngiotensinIIreceptorantagonist(ARB)Aldosterone

antagonists

renininhibitorACEI/ARB

increasing

plasma

renin

activityrenin

inhibitior

has

the

effect

of

cardiorenal

protectionnotACEI/ARBreplacementtherapy英文班內(nèi)科學(xué)心力衰竭第81頁GeneraltreatmentdecreasedburdensincreasedsystolepowerAnti-neurohumoralactivation

RAASinhibitor

-blockersympatheticactivation↑b1receptorsb2receptorsa1receptorsmetoprololbisoprolol↓arrythmiadilatebloodvessels;↓themyocardialO2Cardiactoxicity

carvedilol英文班內(nèi)科學(xué)心力衰竭第82頁GeneraltreatmentdecreasedburdensincreasedsystolepowerAnti-neurohumoralactivation

RAASinhibitor

-blockerInhibitionofsympatheticactivation

improveprognosis1-

blockermetoprolol,bisoprolol

12α-

blokercarvedilolapplicationmethods

startingwithsmalldosesiftolerated,gradually

increasethedosemonitoringofBp,HR,ECG英文班內(nèi)科學(xué)心力衰竭第83頁GeneraltreatmentdecreasedburdensincreasedsystolepowerAnti-neurohumoralactivation

RAASinhibitor

-blocker

Contraindication:

bronchospasm

severebradycardia

≥Ⅱ。atrioventricularblock

severeperipheralvasculardisease

acuteheartfailure

英文班內(nèi)科學(xué)心力衰竭第84頁TreatmentofchronicheartfailureTherecentadvancesaboutthetreatmentofHF

MicturitionrestrainthesympatheticnervoussystemdilatebloodvesselsrhBNPlevosimendanIncreasetheCa2+sensitivity→myocardialcontractilityMediateATP-K+channel→dilatebloodvesselsivabradineInhibiteSANIfcurrenttolvaptanCombineV2receptor→H2O2reabsoption↓英文班內(nèi)科學(xué)心力衰竭第85頁TreatmentofchronicheartfailureNon-medicinetreatment英文班內(nèi)科學(xué)心力衰竭第86頁CardiacResynchronizationTherapy(CRT)英文班內(nèi)科學(xué)心力衰竭第87頁LeftVentricularAssistDevice（LAVD）TransitedtreatmentforhearttransplantationAdjuvanttherapyforacuteHF英文班內(nèi)科學(xué)心力衰竭第88頁TreatmentofchronicheartfailureNon-medicinetreatmenthearttransplantationcellreplacementtherapy--SCT(stemcelltransplantation)英文班內(nèi)科學(xué)心力衰竭第89頁

Acuteheartfailure,AHF英文班內(nèi)科學(xué)心力衰竭第90頁CategoriesofAHF1.Acuteleftheartfailure2.Acuterightheartfailure3.non-cardiacacuteheartfailure英文班內(nèi)科學(xué)心力衰竭第91頁CategoriesofAHFAcuteleftheartfailuredecreasedmyocard