概述-心衰的分级 根据疾病进程对cHF分级: At risk/Stage A: a high risk HF in the future but no structural heart disorder. Stage B: a structural heart disorder but no symptoms at any stage Stage C: previous or current symptoms of heart failure in the context of an underlying HE structural heart problem, but managed with medical treatment Stage D: advanced disease requiring hospital-based support, a heart transplant or palliative care
根据疾病进程对CHF分级: Stage A: a high risk HF in the future but no structural heart disorder; Stage B: a structural heart disorder but no symptoms at any stage; Stage C: previous or current symptoms of heart failure in the context of an underlying structural heart problem, but managed with medical treatment; Stage D: advanced disease requiring hospital-based support, a heart transplant or palliative care 概述-心衰的分级 At risk HF 6
Cardiac failure Cardiac output几 Blood pressure Venous pressure Renal blood flow Renin angiotension I Venous hyperemia Aldosterone Pulmonary Systemic circulation circulation Jugular vein Sodium and water (cough, emptysis,distension, edema) retention dyspnea) Changes of hemodynamics in CHF I
Cardiac failure Cardiac output Venous pressure Venous hyperemia Pulmonary circulation (cough, emptysis, dyspnea) Systemic circulation (jugular vein distension, edema) Blood pressure Renal blood flow Renin, angiotension II Aldosterone Sodium and water retention Changes of hemodynamics in CHF 7
概述CHF的病理生理学 心肌损害 心输出量减少 SNS和RAAS激活 心脏毒性 ANP 血管收缩,血流动 BNP 力学改变 心肌肥厚( hy pertrophy) 心血管重构( remodeling) 发病和死亡 左室功能进行性恶化心衰症状 Fonarow GC. Rev Cardiovasc Med 2001: 2: 7-12
心肌损害 心输出量减少 SNS和RAAS 激活 心脏毒性 心肌肥厚（hypertrophy） 心血管重构（remodeling） 发病和死亡 左室功能进行性恶化 心衰症状 ANP BNP Fonarow GC. Rev Cardiovasc Med..2001;2:7–12. 概述-CHF的病理生理学 8 血管收缩，血流动 力学改变
Actions of angiotensin Constricts vessels, increases peripheral resistance and returned blood volume Increases sympathetic tension, promotes release of sympathetic transmitter Stimulates release of aldosterone(醛固酮) Induces expression of c-fos、c-myc、ciun rapidly, promotes proliferation and remodeling
• Constricts vessels, increases peripheral resistance and returned blood volume. • Increases sympathetic tension, promotes release of sympathetic transmitter. • Stimulates release of aldosterone (醛固酮). • Induces expression of c-fos、c-myc、c-jun rapidly, promotes proliferation and remodeling. Actions of angiotensin II 9
Actions of aldosterone Pro-thrombotic Vascular inflammation Potassium effect Myocardial and injury and fibrosis magnesium loss Deleterious effects Central of aldosterone hypertensive effects Catecholamine potentiation Endothelial Sodium Ventricular dysfunction retention arrhythmias Cardiovascular disease McMahon EG 2001, Current Opinion in Pharmacology
10 Actions of Aldosterone McMahon EG 2001