收缩性心力衰竭ppt课件.pptVIP

/home/eyevstratov Systolic Heart Failure Definition Inability to pump an adequate volume of blood and/or to do so only from an abnormally elevated filling pressure,is that heart failure, can be caused by an abnormality in systolic function leading to a defect in the expulsion of blood i.e. Systolic Heart Failure Causes Coronary artery disease Valvular heart disease Hypertension and aging Diabetes Dilated cardiomyopathy NYHA classification of heart failure symptoms Class 1: No limitations, ordinary physical activity does not cause undue fatige, dyspnoea or palpitation (asymptomatic LVD) Class 2: Slight limitation of physical activity, such patients are comfortable at rest (symptomatically ¨mild¨heart failure) Class 3: Marked limitation od physical activity, less then ordinary physical activity will lead to symptoms (symptomatilcally ¨moderade¨heart failure) Echo Morphological Classification Segmental dysfunction Focal scarring/dyskinesis most likely ischemic origin,but significant regional asymmetry (even without LBBB) often seen in DCM Global dysfunction May be due to any of the causes of systolic dysfunction, including CAD SHF vs Normal Heart Value End diastolic volume 135 mVm2 (N80) End Systolic volume 105 ml/m2 (N40) Stroke volume 30 ml/m2 (N40) Ejection fraction 20 % (N50) End diastolic pressure 25 mmHg (N10) Clinical Symptoms Dyspnoea Fatigue Periferal oedema Orthopnoea Paroxysmal nocturnal dyspnoea Identification of SHF Physiology Preload Afterload Ventricular Hypertrophy Systolic vs Diastolic Dysfunction Treatment of SHF Diuretics Positive Inotropics Drugs Direct-Acting Vasodilators Neurohormonal Antagonists Treatment of SHF Tailored Therapy for Advanced Heart Failure When myocardial ischemia develops, the Frank-Starling line shifts to the right (A).? This will cause less complete emptying of the ventricle and decreased stroke-volume (B).? Compensation involves increasing end-systolic volume (C), but note that this may elevate ventr