freepeople性欧美熟妇, 色戒完整版无删减158分钟hd, 无码精品国产vα在线观看DVD, 丰满少妇伦精品无码专区在线观看,艾栗栗与纹身男宾馆3p50分钟,国产AV片在线观看,黑人与美女高潮,18岁女RAPPERDISSSUBS,国产手机在机看影片

正文內(nèi)容

上海交通大學(xué)醫(yī)學(xué)院-在線瀏覽

2025-02-21 07:23本頁面
  

【正文】 e Peripheral nervous system activity RAAS activity Vagal tone Heart Failure _ZhangQing WORSENING OF CHF % p = DIGOXIN: mg /d ( ng/ml) EF 35% Class IIII (digoxin+diuretic+ACEI) Also significantly decreased exercise time and LVEF. DIGOXIN EFFECT ON CHF PROGRESSION RADIANCE N Engl J Med 1993。Heart Failure _ZhangQing Heart Failure 上海交通大學(xué)醫(yī)學(xué)院 附屬仁濟(jì)醫(yī)院心內(nèi)科 張 清 副教授 Heart Failure _ZhangQing ?Heart failure is the pathophysiological state in which the heart is unable to pump sufficient blood to satisfy the metabolic demands of the body with enough preload. Heart Failure _ZhangQing The Progressive Development of Cardiovascular Disease Endstage Heart Disease Congestive Heart Failure Ventricular Dilation Remodeling Arrhythmia amp。 Loss of Muscle Myocardial Infarction Myocardial Ischemia CAD Atherosclerosis Endothelial Dysfunction Risk Factors Coronary Thrombosis Heart Failure _ZhangQing For progressive duration ? Congestive heart failure is classified into acute and chronic heart failure ? Congestive heart failure is classified into left side, right side and biventricular heart failure For anatomical type Heart Failure _ZhangQing Heart Failure _ZhangQing Chronic heart failure Heart Failure _ZhangQing Causes Fundamental causes: ? impairment of myocardium, such as AMI,cardiomyopathy,myocarditis ? overloading of the heart, such as hypertension, aortic stenosis, mitral stenosis,emphysema,aortic insufficiency,mitral insufficiency,VSD,PDA,ASD. ? diminished LV pliance, such as ventricular hypertrophy Precipitating factors ? infection,especially pulmonary infection, fever ? physical,environmental,or emotional stress ? increased sodium load ? arrhythmia, ? pulmonary emboli ? pregnancy and delivery ? anemia,bleeding,excessive transfusion Heart Failure _ZhangQing Pathophysiology of heart failure ? Impaired myocardium ? ↓ ? Cardiac output ↓, heart failure ? ↓ ? Neurohumoral stimulation ? RAS and sympatheticadrenergic↑ ? ↓ ↓ ? Vasoconstriction increased heart rate ? Salt and water retention increased energy ? (augments preload) expenditure ? Hypertrophy ? ↓ ? Leads to deterioration and death of cardiac cell Heart Failure _ZhangQing Effects of Neurohormonal Stimulation in Heart Failure Heart ? Heart rate ? Contractility ? Stroke volume ? Cardiac output ? Conduction velocity ? Myocardial oxygen consumption Peripheral Circulation ? Arterial vasoconstriction ? Venoconstriction ? Systemic vascular resistance ? Redistribution of blood flow ? Renal vasoconstriction Heart Failure _ZhangQing Pathophysiology of Heart Failure: Left Ventricular Remodeling Leftventricular (LV) remodeling is defined as a change in LV geometry, mass and volume that occurs over a period of time Heart Failure _ZhangQing Heart Failure _ZhangQing Ventricular Remodeling: Compensatory Mechanism Dilation Hypertrophy ? Globular shape Short term: Compensatory Long term: Harmful Heart Failure _ZhangQing DETERMINANTS OF VENTRICULAR FUNCTION STROKE VOLUME PRELOAD CONTRACTILITY CARDIAC OUTPUT HEART RATE Synergistic LV contraction LV wall integrity Valvular petence AFTERLOAD Heart Failure _ZhangQing Vicious Cycle of Heart Failure Myocardial dysfunction Diminished Cardiac output Diminished renal blood flow Renin release Angiotensin II Aldosterone Increased Sympathetic Activity Vasoconstriction Increased force and rate of myocardial contraction Increased cardiac workload Renal retention of sodium and water Increased venous return Edema Heart Failure _ZhangQing Pathophysiology and Therapeutic Approaches to Heart Failure ?LV Function ?Cardiac Output Neurohormonal Activation Salt and Water Retention ?Peripheral vasoconstriction ?Blood flow Vasodialtors ACE Inhibitors Diuretics ACE Inhibitors 223。329:1 Placebo n=93 DIGOXIN Withdrawal DIGOXIN n=85 30 10 0 20 100 80 20 0 40 60 Days Heart Failure _ZhangQing 50 40 30 20 10 0 Placebo n=3403 DIGOXIN n=3397 48 0 12 24 36 OVERALL MORTALITY % DIG N Engl J Med 1997。adrenergic agonists PHOSPHODIESTERASE INHIBITORS Amrinone Enoximone Others Milrinone Piroximone POSITIVE INOTROPES Heart Failure _ZhangQing 223。g / Kg / min) Dobutamine 2 DA1 / DA2 177。 177。1 ++ + + + 177。1 + a ++ ++ ++ 177。1 ++ 177。 Heart Failure _ZhangQing POSITIVE INOTROPES CONCLUSIONS May increase mortality Safer in lower doses Use only in refractory CHF NOT for use as chronic therapy Heart Failure _ZhangQing Venous Vasodilatation MIXED Calcium antagonists aadrenergic Blockers ACEI Angiotensin II inhibitors K+ channel activators Nitroprusside VENOUS Nitrates Molsidomine ARTERIAL Minoxidil Hydralazine VASODILATORS CLASSIFICATION Arterial Vasodilatation Heart Failure _ZhangQing 1 VENOUS VASODILATATION Preload 2 Coronary vasodilatation Myocardial perfusion 3 Arterial vasodilatation Afterload 4 Others Pulmonary congestion Ventricular size Vent. Wall stress MVO2 NITRATES HEMODYNAMIC EFFECTS ? Cardiac output ? Blood pressure Heart Failure _ZhangQing PROBABILITY OF DEATH 0 Placebo (273) Prazosin (183) Hz + ISDN (186) MONTHS VHefT1 N Engl J Med 1986。22:1557 ACEI FUNCTIONAL CAPACITY Quinapril continued n=1
點擊復(fù)制文檔內(nèi)容
教學(xué)課件相關(guān)推薦
文庫吧 www.dybbs8.com
備案圖鄂ICP備17016276號-1