文档介绍：Congestive Heart Failure CHF
SUGAR LAND
HEART CENTER
By
Nik Nikam, .
Interventional Cardiologist
Sugar Land Texas
May 2010
Congestive Heart Failure CHF
SUGAR LAND
HEART CENTER
Epidemiology
Approximately million people have CHF
More than 550,000 cases detected annually
Account for 5 to 10% of all hospitalizations
250,000 deaths per year related to CHF
Five year mortality as high as 60% in men & 45%
in women
Median survival is years for men and years for women
Congestive Heart Failure CHF
SUGAR LAND
HEART CENTER
CHF precipitating factors
pliance with Meds and Diet
Acute MI
Arrhythmia
Pneumonia
Increased Sodium Diet (Holiday Failure)
Anxiety
Pregnancy
Congestive Heart Failure CHF
SUGAR LAND
HEART CENTER
Rhythm problems leading to CHF
Congestive Heart Failure CHF
SUGAR LAND
HEART CENTER
Pathophysiology
Hemodynamic changes
Neurohormonal changes
Cellular changes
Congestive Heart Failure CHF
SUGAR LAND
HEART CENTER
Neurohormonal changes in CHF
RAS, renin-angiotensin system; SNS, sympathetic nervous system.
Myocardial injury to the heart (CAD, HTN, CMP, Valvular disease)
Morbidity and mortality
Arrhythmias
Pump failure
Peripheral vasoconstriction
Hemodynamic alterations
Heart failure symptoms
Remodeling and progressive
worsening of LV function
Initial fall in LV performance, wall stress
Activation of RAAS and SNS
Fibrosis, apoptosis, hypertrophy, cellular/ molecular alterations, myotoxicity
Fatigue Activity altered Chest congestion Edema Shortness of breath
Congestive Heart Failure CHF
SUGAR LAND
HEART CENTER
Neurohormonal changes
N/H changes
Favorable effect
Unfavor. effect
Sympathetic activity
HR , contractility,
vasoconst. V return,
filling
Arteriolar constriction
After load workload
O2 consumption
Renin-Angiotensin –
Aldosterone
Salt & water retention VR
Vasoconstriction
after load
Vasopressin
Same effect
Same effect
interleukins &TNF
May have rol