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1、Heart Failure,Xiaojuan Bai,7 years program of China Medical University,Objective :1.Mastering clinical manifestation ,diagnosis and management of heart failure2.Grasping causes,pathophysiology of heart failure3.Understanding classification and investigation of heart failure,1.general concept1)causes
2、 of heart failure2)precipitating/aggravating factors3)pathophysiology4)type of heart failure2.chronic and acute heart failure 1)clinical manifestation2)investigation3)diagnosis and differential diagnosis4)management,Content,Heart failure is an imprecise term used to describe the state that develops
3、when the heart cannot maintain an adequate cardiac output or can do so only at the expense of an elevated filling pressure.,Definition,pulmonary congestion,systemic venous congestion ,tissue perfusion deficiency due tolow cardiac output .,Clinical Features,left ventricular end-diastolic pressure18mm
4、Hg, right ventricular end-diastolic pressure10mmHg,heart failure = cardiac insuffiency.,Hemodynamic Features,Causes of heart failure,1.Reduced ventricular contractility a. Cardiomyopathy, myocardial infarction. b. Metabolic dysfunction,2.ventricular overload a. pressure overload- hypertension , aort
5、ic stenosis, pulmonary hypertension, pulmonary valve stenosis.b. volume overload - mitral regurgitation, aortic regurgitation , atrial septal defect, ventricular sepals defect , hyperthyroidism, artery-venous fistula. c. ventricular inflow obstruction-hypertrophy , mitral stenosis, tricuspid stenosi
6、s, restrictive cardiomyopathy, constrictive pericarditis .endocardial fibrosis and other disorders that cause a stiff myocardium.,Precipitating / aggravating factors,myocardial ischemia or infarctioninfection arrhythmiapulmonary embolismexertionpregnancy and parturitionanemia intravenous fluid overl
7、oad, electrolytedisturbance, acid-base imbalance,Pathophysiology,1. Frank-Starlings Law of the heart a. The cardiac output is a function of the preload, the afterload, and myocardial contractility.b.Preload: the volume and pressure of blood in the ventricle at the end of diastole.c. Afterload :the a
8、rterial resistance.,2. RAAS in Heart Failure,2. RAAS in Heart Failure,3.myocardium impaired and remodeling,initial myocardium impaired ventricular overload myocardium infarction inflammation,disease progress heart failure complication death,chamber enlargement myocardial hypertrophy embryo gene phen
9、otype extracellular matrix change,secondary conduct factor sympathetic nervous system RAAS endothelins TNF- ,IL-6 mechanical stress oxidative stress,4.Diastolic heart failureHeart failure may develop as a result of poor ventricular filling and high filling pressure caused by abnormal ventricular rel
10、axation,sarcoplasmic reticulum intake Ca2+free Ca2+ in myocyte degrade slowly b. In CHD with obvious ischemia ,before contractility dysfunction, have occurred relaxation dysfunctionc. In hypertrophy and hypertrophic cardiomyopathy, left ventricular end-diastolic filling pressure pulmonary hypertensi
11、on ,pulmonary congestion diastolic heart failure,relaxation dysfunction,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
12、 dysfunction 5.Asymptomatic and congestive 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, t
13、he above manifestationoccur in the majority of CHF.High output heart failure:Extremities warm,flush, difference of pulse pressure increase, seen in hyperthyroidism,anemia,pregnancy,Systolic dysfunction Heart failure may develop as a result of impaired myocardial contraction .Diastolic dysfunctionHea
14、rt 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.,1 Chronic heart failure Definitionsame meaning as congestive heart failure,clinic
15、al 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,3)Orthopnea: in decubitus,blood volume flow to heart increase elevated enddiastolic filling pressure pulmonary venous and capillary pressure increase interstitial pulmonary edema pulmonary compliance decrease respiratory resistance 4)acute pulmonary edema,
