深度和节律的改变Dyspneaonexertion劳力性呼吸困难Orthopnea端.ppt

Heart Failure 心衰,approx.100,000 heartbeats/day approx.2,760,000,000 heartbeats/lifetime approx.4,000 gallons(15,000 liters)blood pumped/day appox，3，832，500，000 liters/lifetime,小型水库 1000m3 中型水库 1000 m3 大型水库 100,000 000m3 龙泉驿水库 蓄水约 330万立方米,Concept 概念 Pathogenesis 发病机制 Effect（important）and mechanisms 影响及机制,Outline大纲,Background 背景 Definition and explaining the definition 定义 pathogenesis 机制,Content 内容,心为君主之官，脏腑百骸，惟所是命，聪明智慧，莫不由之,The heart is more deceitful than anything.It is incurable who can know it?Jeremiah 17:9-10,Heart failure 心衰-Background,Heart failure 心衰-Background,Cats look down on us.Dogs look up to us.Pigs treat us as equals,Heart failure 心衰-Background,What kill us?,Background,2010年中国心血管病报告,1/5 adults suffer from cardiovascular disease 3 million die from cardiovascular disease account for 41%of death number China death 1/11.6s America death 1/34.0s equivalent to once Wen chuan big earthquake,Background,the report of cardiovascular disease in china 2010,hypertension 高血压 2亿人 myocardial infarction 心肌梗 200万人 pulmonary heart disease 肺心病 500万人 rheumatic heart disease 风心病 250万人 congenital heart disease 先心病 200万人 heart failure 心衰竭 420万人,2010年中国心血管病报告,the report of cardiovascular disease in china 2010,Background,We Face an epidemic of HF,Affecting 0.4-2%of total population，8-10%of elderly The global HF patients have up to 2250 million，increasing at 200 million per year The prognosis of HF similar to cancer or even worse The 20%patients with HF readmission after discharged from hospital in 30 days Less than 50%patients survival 5 years from the diagnosis of heart failure Average survival time is 16 month，in hospital only 25%survival 5 years,Background,0,20,40,60,80,100,Heart disease,Cerebrovascular,malignancy,accidental,respiratory,gastrointestinal,communicable,Urinary system,Neuropsychosis,Endocrinosis,Life style,Biogentics,Environmental factors,Health care,Top 10 cause of death in China and the main risk factors%,Forecasting the future of cardiovascular disease in the United States Circulation 2011;123(8):933-944,Estimated direct and indirect cost of major cordial disease In united state in 2010,The Economic Burden Of Cardiovascular Diseases,Coronary heart disease,Hypertensive disease,Stroke,Heart failure,$53.9,$34.4,Cost in billion,$105.9,$93.5,Clinical intervention,生,死,Low riskstate,Dangerous state,Early change,Different prognosis,Clinicdisease,Sub-clinic symptoms,Prevent intervention,Hypertension hyperlipidmia smoking diabetes obey hereditary,psychological intervention,National standard life style,drug operation physics,Background,heath sub-health sub-clinic disease,Risk Factors,Endothelial Dysfunction,Atherosclerosis,Coronary artery disease,Myocardial Ischemia,Coronary Thrombosis,Myocardial Infarction,Arrhythmia&Loss of Muscle,Remodeling,Ventricular Dilation,Congestive Heart Failure,End stage Heart Disease,The Progressive Development of Chronic Cardiovascular Disease 慢性心血管疾病渐进式发展,心功不全 insufficiency,分级:The New York Heart Association Functional Class(NYHA-FC),心肌收缩力因各种病因减弱（原发或继发），不能将静脉回心血量等量搏出，因而使心输出量绝对或相对减少，使体循环和/或肺循环静脉系统淤血，动脉系统供血不足，不能满足人体在静息状态或一般活动时代谢的的需要，从而出现一系列的心脏循环障碍的症状和体征。,大循环 心功 临床,心肌衰竭：原发性心肌病变，如心肌炎，心肌梗塞 Myocardial failure：primary myocardial lesions，myocarditiis 心力衰竭：不仅仅是心脏问题，如缩窄性心包炎Heart failure：not only heart problem，contractive pericarditis 充血性心衰：慢性经过，血容量增加，出现水肿 Congestive heart failure：chronic，blood，edema,心肌收缩力因各种病因减弱（原发或继发）,Expounding,Myocardial contractility is impaired by various causes（primary or secondary).,fibrinous pericarditis,心肌收缩力因各种病因减弱（原发或继发）,Expounding,Underlying Causes of HF 心衰的基本病因,CAD the commonest 2/3Hypertension in 4%Toxic injury in 2%-4%Valve diseases in 4%Unknown in 20%,Common Causes of HF 心衰的常见病因,诱因 precipitation cause（Aggravating Factors）,Infections Arrhythmias(AF)Pregnancy and childbirth be heated with passion too fast to transfusion,any factor that increase cordial load or injure heart precipitation is not always precipitation,Attention,Expounding,心输出量绝对或相对降低,Hyperdynamic status Increased ventricular preloadATP consumption increased and production decreased,high cardiac output HF（1%）low cardiac output HF,notes：other classification self-study,cardiac output reduce absolutely or relatively,dermatophytosis barbiers=beriberipanneuritis epidemica dietetic neuritis endemic neuritis,脚气与脚气病,香港脚 Hong Kong foot 运动员脚 athlete foot,burning,itching，cracking,糖代谢脱羧酶的辅酶Coenzyme of decarboxylase in Sugar metabolism参与-酮酸的氧化脱羧Participate in-keto acid oxidative decarboxylation,VitB1(thiamin 硫胺素)：,葡萄糖 glucose,酵解glycolysis,乳酸Lactic acid,丙酮酸 pyruvic acid,TCA循环,乙酰辅酶A,丙酮酸,NADH,NAD+,NADH,NAD+,发酵 ferment,呼吸链递氢,NADH,NAD+,VitB1丙酮酸脱氢酶系,参与-酮酸的氧化脱羧 丙酮酸 乳酸堆积,CO2,H+,Beriberi：comes from aSinhalesephrase Meaning：“weak,weak”or“I can not,I can not”,备急千金要方考诸经方往往有脚弱之论，而古人少有此疾。自永嘉南渡，衣缨士人，多有遭者。风毒中人，随处皆得，作病何偏着于脚也？答曰夫人有五脏，心肺二脏，经络所起在手十指；肝肾与脾三脏，经络所起在足十趾。夫风毒之气，皆起于地。地之寒暑风湿皆作蒸气，足常履之，所以风毒之中人也必先中脚；久而不瘥，遍及四肢腹背头项也；微时不觉，痼滞乃知。经云次传、间传是也。,东晋、六朝时叫脚弱孙思邈称为风毒脚气,内经诸病源候论脚气病治法总要,infant beriberi crying,but not loudly and without tears.Mayb