Heart Failure,Contents,Epidemiology of HF Definition of HF Pathophysiology of HF Diagnosis of HF Treatment of HF,Epidemiology 2013 China,中国成人患病率为 : 0.9% 估计中国心衰总人数约为 450万 男性 0.7 % ; 女性 1.0% 北方：1.4%; 南方：0.5% 城市人口:1.1%;农村人口:0.8%,Epidemiology,What is HF?,Limitation of life ability,Definition of HF,Heart failure is a pathophysiologic state in which an abnormality of cardiac function is responsible the failure of the heart to pump blood to commensurate with the requirements of the metabolizing tissues. Heart failure is a complex clinical syndrom that can result from any structure or functional disorder that impair the ability of the ventricle to fill with or eject blood.(ACC2005) HF is a pathophysiological state in which cardiac output is insufficient for the bodys needs.,Historical of HF definition,Classification of heart failure,the side of the heart involved, (left heart failure versus right heart failure) whether the abnormality is due to contraction or relaxation of the heart (systolic dysfunction vs. diastolic dysfunction) whether the problem is primarily increased venous back pressure (behind) the heart, or failure to supply adequate arterial perfusion (in front of) the heart (backward vs. forward failure) whether the abnormality is due to low cardiac output with high systemic vascular resistance or high cardiac output with low vascular resistance (low-output heart failure vs. high-output heart failure),Systolic vs Diastolic Dysfunction,HFrEF / HFpEF,NYHA Functional classification,Class I: no limitation is experienced in any activities; there are no symptoms from ordinary activities. Class II: slight, mild limitation of activity; the patient is comfortable at rest or with mild exertion. Class III: marked limitation of any activity; the patient is comfortable only at rest. Class IV: any physical activity brings on discomfort and symptoms occur at rest.,Four Stage of HF (ACC/AHA2005),Stage A: Patients at high risk for developing HF in the future but no functional or 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.,Based on Pathophysiology,A new classification,Common causes of HF,Ischaemic Heart Disease 62% Cigarette Smoking 16% Hypertension (high blood pressure)10% Obesity 8% Diabetes 3% Valvular Heart Disease 2% (much higher in older populations),A 19 year study of 13000 healthy adults in the United States (the National Health and Nutrition Examination Survey (NHANES I),Rarer causes of heart failure,Viral Myocarditis (an infection of the heart muscle) Infiltrations of the muscle such as amyloidosis HIV cardiomyopathy (caused by Human Immunodeficiency Virus) Connective Tissue Diseases such as Systemic lupus erythematosus Abuse of drugs such as alcohol Pharmaceutical drugs such as chemotherapeutic agents. Arrhythmias,Precipitating Factors,Infection(pulmonary) Arrhythmia Excessive salt intake inadequate exercise/emotional crisis inadequate treatment: digitalis/inadequate usage diuretic pulmonary emboli pregnancy and delivery Thyrotoxicosis/anemia,Pathophysiology(1),Hemodynamic disorder: SV Determinants of pump function 1.preload 2.afterload 3.contractility 4.HR,CO=SV*HR SV=EDV-ESV EF=SV/EDV,Preload/afterload/contractility,Preload on SV Frank Starling Law,SV & pre/after load,Pathophysiology(2),SNS/RAS ANF activation,Myocardial Injury and remodeling,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 Blockers,Digoxin,Pathophysiology of Heart Failure: Left Ventricular Remodeling,Left-ventricular (LV) remodeling is defined as a change in LV geometry, mass and volume that occurs over a period of time,Common Symptoms of Heart Failure,Dyspnea on exertion Paroxysmal nocturnal dyspnea Orthopnea Fatigue Lower extremity edema Cough, usually worse at night Nausea, vomiting, anorexia, ascites Sleep disorders Increased abdominal girth,Common Physical Findings of Heart Failure,Elevated jugular venous pressure Hepatojugular reflux Displaced apical impulse S3 gallop Pulmonary rales Hepatomegaly Peripheral edema Ascites,Assessment of jugular venous distention,Clinical manifestation,Left heart failure: SOB, cough, rales, gallop Right heart failure: gastrointestinal congestion, nausea,a sense of fullness after meals, hepato-jugular reflux,swelling of feet or ankles Low cardiac output: fatigue and weakness, oliguria Biventricular heart failure: both clinical manifestation of left and right heart failure,one of which maybe predominant.,How to make a diagnosis of HF?,Search for the evidence of lower EF, but,Framingham Criteria-main, Paroxysma