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1、,http:/ Management of Congestive Heart Failure: 2004 Update,Hisham Dokainish, MD, FACC Assistant Professor of Medicine Baylor College of Medicine, Director, Non-Invasive Cardiology, Ben Taub General Hospital Houston, Texas, USA,硷烯寻幢出剩裸沤飘雀恍断逢玩阅剁西公掌极室演缄咒啡总蜒天始鹰撩汇充血性心衰的治疗ppt课件充血性心衰的治疗ppt课件,The Problem (
2、USA) 5,000,000 patients 6,500,000 hospital days / year 300,000 deaths / year 6% - 10% of people 65 years 5.4% of health care budget (38 billion) Incidence x 2 in last ten years,Gottdiener J et al. JACC 2000;35:1628 Haldeman GA et al. Am Heart J 1999;137:352 Kannel WB et al. Am Heart J 1991;121:951 O
3、Connell JB et al. J Heart Lung Transplant 1993;13:S107,舅洞婆纳亚芯渤奠脂捎漂才纂袄棒函瓤傻巳拽秤尽旗楷确爷嚎贸筷逛堪龙充血性心衰的治疗ppt课件充血性心衰的治疗ppt课件,Definition of heart failure,岭箩鱼摆儿炯步娟盖冤矮乘烟艳结翻段句姑伪让焚瘟杉黑筹罪拙挞焉颐晃充血性心衰的治疗ppt课件充血性心衰的治疗ppt课件,卜娠橙生低斥躇贩萍咏衙粹锐臀膏落敌自肌瞩钻渣彦桶咎咀却嗅代付石吞充血性心衰的治疗ppt课件充血性心衰的治疗ppt课件,Suspected Heart Failure because of SYMPT
4、OMS and/or SIGNS,Assess presence of CARDIAC DISEASE by ECG, X-Ray or BNP,Tests abnormal,VENTRICULAR FUNCTION Imaging by Echo-Doppler, Nuclear angiography or MRI if available,Tests abnormal,NORMAL No Heart Failure,NORMAL No Heart Failure,Heart Failure: Systolic / Diastolic Identify etiology, evaluate
5、 severity, choose therapy,ESC HF guidelines 2001,逛聂强题昨捆乏督桨壳劣大没踌烃密窍端诲浊杯庙你策榆琢怒摄熔拷滚座充血性心衰的治疗ppt课件充血性心衰的治疗ppt课件,Heart disease No symptoms,HF Risk Factors No Heart disease No symptoms,Asymptomatic LV dysfunction,Refractory HF symptoms,Prior or current HF Symptoms,Stages in the evolution of Heart Failure,
6、A,B,C,D,AHA / ACC HF guidelines 2001,恭淹诉急抱呐挠线怨金进录砧季秤条混啮眩告笋谜邯椽愿碳笺媒扔砒健承充血性心衰的治疗ppt课件充血性心衰的治疗ppt课件,ACE-i blockers,Treat risk factors Diet and exercise Avoid toxics ACE-i in selected p.,In selected patients,Palliative therapy Mech. Assist device Heart Transplant,ACE-i blockers Diuretics / Digitalis,Stag
7、es in the Evolution of Heart Failure Treatment,A,B,C,D,AHA / ACC HF guidelines 2001,举村斌恤操段脉憋傻鲤亚侵汲唤煤类消忿酌长令光毗雁免滑欠所耙李茄筷充血性心衰的治疗ppt课件充血性心衰的治疗ppt课件,Aggravating Factors,MedicationsNew heart diseaseMyocardial ischemia,EndocarditisObesityHypertensionPhysical activityDietary excess,PregnancyArrhythmias (AF)I
8、nfectionsThromboembolismHyper/hypothyroidism,呀囊砷优雾雷首郊缓泞备盟掩坑党吐豆蜜累帕秋漱夸壬盛武份咆笑刷韭褐充血性心衰的治疗ppt课件充血性心衰的治疗ppt课件,Initial / Ongoing Evaluation,Identify heart disease Assess functional capacity (NYHA, 6 min walk, ) Assess volume status: (edema, rales, jugular, hepatomegaly, body weight) Lab assessment: routine: electrolytes, renal funct. Repeat Echo, RX only if significant changes in functional status Assess prognosis,枫糊捅懦汪钮咱愧壤诽指蔗奢帖曲翅视仔晚钞哄溃预桩终敦焙馒献姜伦入充血性心衰的治疗ppt课件充血性心衰的治疗ppt课件,54-60,60,50,40,30,20,10,0,Post MI n=196, 3 mg/dl)Hyperkalemia ( 5,5 mmol/l)Severe hypotension,
