英文班内科学心力衰竭Heartfailure(HF)CategoriesofHFstageofHFNewYorkHeartAssociationFunctionalClassificationStageandClassofHF6-minwalkdistanceFundamentalcausesFundamentalcausesFundamentalcausesFundamentalcausesPrecipitatingcausesPathogenesisandpathophysiology1.Compensateheartfailure1.Compensateheartfailure1正常静息1.Compensateheartfailure心力衰竭——神经体液的代偿和失代偿心肌细胞死亡2.RAASinHeartFailure1.Compensateheartfailure2.Ventricularremodeling2.Ventricularremodeling3.aboutdiastolicinsufficiency4.somecytofactorstakepartinheartfailureChronicheartfailure,CHFClinicalmanifestations1.Leftheartfailure1.Leftheartfailuresign2.Rightheartfailure2.Rightheartfailure3.Wholeheartfailurelaboratoryexamination呼吸困难,虚弱,运动受限等症状laboratoryexaminationECG(electrocardiogram)X-rayEchocardiogramCardiacCatheterizationCardiopulmonaryExerciseTesting(CPET)Diagnosisanddifferentialdiagnosis2.Differentialdiagnosis:2.Differentialdiagnosis:2.Differentialdiagnosis:TreatmentofchronicheartfailureTreatmentofchronicheartfailureGeneraltreatmentGeneraltreatmentGeneraltreatmentThemainpointofdiureticsapplication襻利尿剂应作为首选。噻嗪类仅适用于轻度液体潴留、伴高血压和肾功能正常的心衰患者(I类，B级)。利尿剂通常从小剂量开始(氢氯噻嗪25mg/d，呋塞米20mg/d，托塞米10mg/d),逐渐加量。一旦病情控制即以最小有效量长期维持。每日体重变化是最可靠检测利尿剂效果和调整利尿剂剂量的指标。长期服用利尿剂应严密观察不良反应的出现如电解质紊乱、症状性低血压，以及肾功能不全，特别在服用剂量大和联合用药时（Ⅰ类，B级）。GeneraltreatmentThemainpointofVasodilatorapplicationGeneraltreatmentGeneraltreatmentGeneraltreatmentGeneraltreatmentGeneraltreatmentGeneraltreatmentGeneraltreatmentArrhythmiaofdigitalispoisoningGeneraltreatmentGeneraltreatmentGeneraltreatmentGeneraltreatmentGeneraltreatmentGeneraltreatmentAII产生是通过多种通道GeneraltreatmentGeneraltreatmentGeneraltreatmentGeneraltreatmentGeneraltreatmentGeneraltreatmentGeneraltreatmentGeneraltreatmentGeneraltreatmentGeneraltreatmentGeneraltreatmentGeneraltreatmentTreatmentofchronicheartfailureTreatmentofchronicheartfailureCardiacResynchronizationTherapy(CRT)LeftVentricularAssistDevice（LAVD）TreatmentofchronicheartfailureCategoriesofAHFCategoriesofAHFCategoriesofAHFCategorie