北大医院内部心血管心力衰竭课件.ppt

* 心率、节律，电压(心腔大小、LVH vs.心包积液，浸润性疾病），QRS波宽度(心室不同步)，病因(陈旧心肌梗死) 心肌损伤(心梗三项)，心室张力，其他原因(肺栓塞) * * (靴形、梨形，双侧) * Transmitral Doppler flow demonstrating the stages of diastolic dysfunction. Panel A represents a young normal, with brisk early filling after the opening of the mitral valve (E wave), and a smaller atrial component (A wave), with a ratio of greater than 1.5 : 1. With early diastolic dysfunction (stage 1), impaired early relaxation leads to a lower gradient between the left atrium and left ventricle after mitral opening, and the E wave component lessens in velocity and increases in duration (Panel B). The ratio of E to A lessens to the 0.75 : 1, and deceleration time increases, usually between 150–270 ms. Panel C demonstrates the phenomenon of ‘pseudonormalization’, known as stage 2 diastolic dysfunction. As left atrial pressure rises, the pressure gradient between the left atrium and left ventricle increases, and the E wave velocity increases relative to the A wave. This 1 : 1 ratio is seen in older normals, and is therefore called pseudonormalization. The underlying relaxation abnormality can be elicited by Valsalva maneuver which decreases left atrial pressure and unmasks the underlying E to A reversal. Stage 3 diastolic dysfunction is shown in Panel D. Further decrease in left ventricular compliance, elevation of left atrial pressure and loss of atrial function lead to a restrictive pattern, with shortened early filling (deceleration time less than 140 ms) and diminished A wave (E to A ratio 1.5 : 1), as the atrium fails to generate pressure. Note the similarity between end stage restrictive physiology and the young normal. * Four phases of diastolic dysfunction—The progressive increase in left atrial and left-ventricular end-diastolic pressures is seen as the grade of diastolic dysfunction increases (upper panel). The left-ventricular inflow pattern is seen just below these curves, as well as the mean left-atrial pressure (LAP) and the New York Heart Associati