1、慢性心力衰竭最新指南解读田野 教授哈尔滨医科大学附属二院心内科第五届北方介入心脏病学暨心血管疾病诊疗新进展国际研讨会 2009.01.11 哈尔滨ESC-51 COUNTRIESContent Definition and diagnosis Diagnostic techniques Non-pharmacological management Pharmacological therapy Devices and surgery Co-morbidities and special populationsDefinition and diagnosis“The very essence o
2、f cardiovacular medicine is the recognition of early heart failure”Sir Thomas Lewis,1933Definition of HF Importantly, it was emphasised that the diagnosis is not dependent on a certain ejection fraction (EF), although it has implications for prognosis.Common clinical manifestationsClinical manifesta
3、tionsFatigueCoughBreathlessness Swollen anklesDepression Weight gainLoss of appetiteNeed to urinate at night Palpitation Swollen abdomen Classification of HFCommon causes of HFCoronary heart disease Many manifestationsHypertension Often associated with left ventricular hypertrophy and ejection fract
4、ionCardiomyopathies Familial/genetic or non-familial/non-genetic (including acquired, e.g. myocarditis) Hypertrophic (HCM), dilated (DCM), restrictive (RCM), arrhythmogenic right ventricular (ARVC), unclassifiedDrugs -Blockers, calcium antagonists, antiarrhythmics, cytotoxic agents Toxins Alcohol, m
5、edication, cocaine, trace elements (mercury, cobalt, arsenic) Endocrine Diabetes mellitus, hypo/hyperthyroidism, Cushing syndrome, adrenal insufficiency, excessive growth hormone, phaeochromocytomaNutritional Deficiency of thiamine, selenium, carnitine. Obesity, cachexiaInfiltrative Sarcoidosis, amy
6、loidosis, haemochromatosis, connective tissue diseaseOthers Chagas disease, HIV infection, peripartum cardiomyopathy, end- stage renal failureClassification of HF New onset First presentation Acute or slow onset Transient Recurrent or episodic Chronic Persistent Stable, worsening, or decompensated Time is important for various types of heart failure.
