(Cardiac Insufficiency)
(introduction)
(Concept of heart failure)
(Cardiac insufficiency & heart failure)
(Concept of congestive heart failure)
(Underlying and predisposing causes of heart failure)
(Underlying Causes) (Impaired myocardium) (Overload for ventricle)
B1
Pressure overload overload
(Predisposing factors)
(Classification of heart failure)
/
(acute heart failure) (chronic heart failure) (mild heart failure) (moderate heart failure) (severe heart failure)
NYHA Grades for cardiac function I: II:,, III:, IV: AHA/ACC grades for cardiac function A:, B:, (NYHAI) C: (II, IIIIV) D: (IV)
(Compensatory mechanisms to cardiac insufficiency)
- (Neurohumoral activation) (activation of sympathetic nervous system) - (activation of renin-angiotensin- system)
+ RAAS
1.
2. Frank-Starling 1.7 2.1 2.2 2.7 µm
+ camp + PKA -p
(ventricular remodeling)
1 (concentric hypertrophy) (eccentric hypertrophy) 2
AngII
(Extracardial Compensation)
()
()
()
(Mechanisms of heart failure)
(Decreased myocardial contractility) (Impaired myocardial diastolic properties) (Inconsistent behavior in systolic and diastolic function of the heart)
(Decreased myocardial contractility) 1. 2. 3.
2.
3. -
1. 14ml/dl 2. 3.
2. ATP (CP) CP
3. ATP Ca 2+ -Mg 2+ -ATP ATP ATP
() - 1. Ca 2+ 2. Ca 2+ 3. Ca 2+
1. Ca 2+ Ca 2+ ; Ca 2+ -ATP/ Ca 2+
2. Ca 2+ Ca 2+
3. Ca 2+ H + Ca 2+,Ca 2+ -
(Impaired myocardial diastolic properties)
ATP ATP Ca 2+ Ca 2+ -
(Inconsistent behavior in systolic and diastolic function of the heart)
(Consequences of the pumping dysfunction)
- (Forward failure) (backward failure)
(Forward failure) (syndrome of low output)
1. (cardiac output, CO) 2.(cardiac index, CI) 3. (ejection fraction, EF ) (stroke volume, SV) (ventricular end diastolic volume, VEDV)
4. 5. (pulmonary capillary wedge pressure, PCWP) (left ventricular end diastolic pressure, LVEDP) (central venous pressure, CVP) (right ventricular end diastolic pressure, RVEDP)
6.
(Backward failure) (syndrome of venous congestion) (systemic congestion) (pulmonary congestion)
() (Systemic congestion) CVP>16 cmh 2 O
() (Pulmonary congestion) PCWP>18 mmhg
: (dyspnea) :
: (dyspnea on exertion) (orthopnea) (paroxysmal nocturnal dyspnea)
: (dyspnea on exertion)
: (orthopnea)
(paroxysmal nocturnal dyspnea)
(Pathophysiological basis of prevention and treatment for heart failure )
Prevnting underlying causes and eliminating predisposing factors) (Improving the pumping function) ( ACEI
(Normalizing neurohumoral regulation & intervening ventricula remodeling) ACEIAng (Replacing severe failing heart)