充血性心衰的治疗课件

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1、CurrentManagementofCongestiveHeartFailure:2004UpdateHishamDokainish,MD,FACCAssistantProfessorofMedicineBaylorCollegeofMedicine,Director,Non-InvasiveCardiology,BenTaubGeneralHospitalHouston,Texas,USATheProblem(USA)•5,000,000patients•6,500,000hospitaldays/year•300,000deaths/year

2、•6%-10%ofpeople>65years•5.4%ofhealthcarebudget(38billion)•Incidencex2inlasttenyearsGottdienerJetal.JACC2000;35:1628HaldemanGAetal.AmHeartJ1999;137:352KannelWBetal.AmHeartJ1991;121:951O’ConnellJBetal.JHeartLungTransplant1993;13:S107DefinitionofheartfailureAHA/ACCHFguidelines200

3、1ClinicalsyndromethatcanresultfromanystructuralorfunctionalcardiacdisorderthatimpairstheabilityoftheventricletofillwithorejectbloodSuspectedHeartFailurebecauseofSYMPTOMSand/orSIGNSAssesspresenceofCARDIACDISEASEbyECG,X-RayorBNPTestsabnormalVENTRICULARFUNCTIONImagingbyEcho-Doppl

4、er,NuclearangiographyorMRIifavailableTestsabnormalNORMALNoHeartFailureNORMALNoHeartFailureHeartFailure:Systolic/DiastolicIdentifyetiology,evaluateseverity,choosetherapyESCHFguidelines2001HeartdiseaseNosymptomsHFRiskFactorsNoHeartdiseaseNosymptomsAsymptomaticLVdysfunctionRefrac

5、toryHFsymptomsPriororcurrentHFSymptomsStagesintheevolutionofHeartFailureABCDAHA/ACCHFguidelines2001ACE-iblockersTreatriskfactorsDietandexerciseAvoidtoxicsACE-iinselectedp.InselectedpatientsPalliativetherapyMech.AssistdeviceHeartTransplantACE-iblockersDiuretics/DigitalisStage

6、sintheEvolutionofHeartFailureTreatmentABCDAHA/ACCHFguidelines2001AggravatingFactorsMedicationsNewheartdiseaseMyocardialischemiaEndocarditisObesityHypertensionPhysicalactivityDietaryexcessPregnancyArrhythmias(AF)InfectionsThromboembolismHyper/hypothyroidismInitial/OngoingEvalua

7、tionIdentifyheartdiseaseAssessfunctionalcapacity(NYHA,6minwalk,…)Assessvolumestatus:(edema,rales,jugular,hepatomegaly,bodyweight)Labassessment:routine:electrolytes,renalfunct.RepeatEcho,RXonlyifsignificantchangesinfunctionalstatusAssessprognosis8070605040302054-60>605040302010

8、0PostMIn=196<3031-3536-4546-53CardiacMortality%LVEFBrodieB.e