Cardiac insufficiency

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• Cardiac insufficiency
• (dysfunction)

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???????(congestive heart failure, CHF)

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• 1.??????(excessive pressure load)
• 2.??????(excessive volume load)

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?????(NYHA or AHA)

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?????????(high output heart failure)

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(No Transcript)
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(?)????(myocardial hypertrophy)

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(No Transcript)
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nnormal cconcentric ddilated hthickness rradi
us ppressure Ttension
Normal Heart
pr
T
2h
Concentric Hypertrophy
Dilated Hypertrophy
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(No Transcript)
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• FACES...
• Fatigue
• Activities limited
• Chest congestion
• Edema or ankle swelling
• Shortness of breath

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• ACEI
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???????????(ACEI)

• ??39???ACE-?????????????????24(8308?,1361???)
• ??????,??????????,?????????(Lancet 1998 , 352)

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ß?????

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???(ET)

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• ??ET?????bosentan(???????)

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???(ALD)

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???????

• ???TNFa??IL-6
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????

• ???MDA?

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The Treatments for Heart Failure

• Diuretics or water pills- helps control
  symptoms
• Digoxin - helps control symptoms
• ACE Inhibitors - can slow down disease
  progression
• Beta Blockers - can slow down disease progression
  

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The End
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???Ca2??????
Ca2?????
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PLN?????
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Na/Ca2??????
RyR??
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Ca2????
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????ATP???

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CHF?????

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CHF?????

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CHF?????
CHF???????????????
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CHF?????
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CHF?????
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Clinical example -- 1

• A 60-year-old man sustained an extensive acute
  myocardial infarction 4 years before his recent
  admission. Since that time, he has become
  progressively more breathless on exertion. During
  the past 6 months, he developed swelling of his
  abdomen and feet despite vigorous diuretic and
  digoxin therapy. Examination revealed an
  emaciated man who was breathless even at rest.
  Cardiac rhythm was regular and blood pressure was
  90/60 mm Hg. Jugular venous pressure was elevated
  and there was ankle edema, hepatomegaly, and
  ascites.

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Clinical example -- 1

• Heart sounds were faint but a loud third sound
  was audible. Chest x-ray revealed marked cardiac
  enlargement, bilateral pleural effusions, and
  pulmonary venous congestion. Cardiac
  catheterization revealed severe inoperable
  three-vessel coronary artery disease, poor left
  ventricular function with marked elevation of
  left ventricular end-diastolic pressure, and low
  cardiac output.

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Clinical example -- 2

• A 35-year-old man presented with a complaint of
  increasing shortness of breath. This initially
  occurred with exertion, but now occurred at rest
  as well. He had no previous cardiac symptoms. His
  father suffers from chest pain and heart failure.
  Examination revealed a normal upstroke and bifid
  systolic impulse on palpation of the carotid
  artery. Presystolic and forceful sustained
  systolic apical impulses were palpable.

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Clinical example -- 2

• The first and second sounds were normal. A loud
  fourth sound was heard. A systolic ejection
  murmur that increased with valsalva was heard
  along the left sternal border. Echocardiogram
  revealed a markedly hypertrophied left ventricle
  with disporportionate thickening of the septum
  and a small left ventricular cavity.