慢性心衰指南课件（ppt_52页）

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1、Relationshipbetweencardiacdysfunction,HFandHFrenderedasymptomaticNORMALCARDIACDYSFUNCTIONCORRECTEDORRESOLVEDCARDIACDYSFUNCTIONSYMPTOMSHEARTFAILURETHERAPYTherapyCANbewithdrawnwithoutrecurrenceofsymptomsSymptomsrelievedTherapyCANNOTbewithdrawnwithoutrecurrenceofsymptomsTransientHeartFailure

2、NosymptomsAsymptomaticcardiacdysfunctionSystolicdysfunctionSymptomspersistDiagnosisAccordingtotheWorkingGroupinHeartFailure,HeartFailureisasyndromewherethediagnosishasthefollowingessentialcomponents:Acombinationof:Symptoms,typicallybreathlessnessorfatigueCardiacdysfunctiondocumentedatrestThedia

3、gnosisissupportedby:ResponsetotreatmentdirectedtowardsheartfailureAssessmentsinallcasesNecessarySupportsOpposesHistorywithsymptoms+++IfabsentObjectiveevidence+++IfabsentResponsetotreatment++EstablishdiagnosisTestNecessarySupportsOpposesElectrocardiogram++IfnormalEchocardiography+++IfnormalChestx-ra

4、yIfcongestionIfnormalBloodcountIfnormalBloodchemistryIfnormalTestsforDiagnosisAdditionalTestsforDiagnosisTestNecessarySupportsOpposesExercisetestIfnormalNatriureticpeptideIfelevatedIfnormalCardiaccath.IfnormalTesttoExcludeAlternativesChestx-ray(Lungdisease)PulmonaryfunctionBloodchemistry(Renalandhe

5、paticdisease)Bloodcount(Anaemia)Exercisetolerance(ifimpaired)ElectrocardiographyAnormalECGsuggeststhatthediagnosisofheartfailureshouldbecarefullyreviewed.ThepredictivevalueofanormalECGtoexcludeLVsystolicdysfunctionexceeds90%ChestX-rayAhighpredictivevalueofX-rayfindingsisonlyachievedbyinterpretingth

6、eminthecontextofclinicalfindingsandECGanomalies.ItisusefultodetectcardiacenlargementandpulmonarycongestionInchronicheartfailure,increasedcardiacsizeandpulmonaryvenouscongestionareusefulindicatorsofabnormalcardiacfunctionwithdecreasedejectionfractionand/orincreasedLVfillingpressureHowever,cardiomega

7、lyisfrequentlyabsentinacuteheartfailureandincaseswithdiastolicdysfunctionPulmonaryfunctiontestsMeasurementsoflungfunctionareoflittlevalueindiagnosingchronicheartfailure.However,theyareusefulinexcludingrespi