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1、CurrentManagementofCongestiveHeartFailure:2004UpdateTheProblem(USA)?5,000,000patients?6,500,000hospitaldays/year?300,000deaths/year?6%-10%ofpeople>65years?5.4%ofhealthcarebudget(38billion)?Incidencex2inlasttenyearsGottdienerJetal.JACC2000;35:1628HaldemanGAetal.AmHeartJ19
2、99;137:352KannelWBetal.AmHeartJ1991;121:951O’ConnellJBetal.JHeartLungTransplant1993;13:S107DefinitionofheartfailureAHA/ACCHFguidelines2001ClinicalsyndromethatcanresultfromanystructuralorfunctionalcardiacdisorderthatimpairstheabilityoftheventricletofillwithorejectbloodSus
3、pectedHeartFailurebecauseofSYMPTOMSand/orSIGNSAssesspresenceofCARDIACDISEASEbyECG,X-RayorBNPTestsabnormalVENTRICULARFUNCTIONImagingbyEcho-Doppler,NuclearangiographyorMRIifavailableTestsabnormalNORMALNoHeartFailureNORMALNoHeartFailureHeartFailure:Systolic/DiastolicIdentif
4、yetiology,evaluateseverity,choosetherapyESCHFguidelines2001HeartdiseaseNosymptomsHFRiskFactorsNoHeartdiseaseNosymptomsAsymptomaticLVdysfunctionRefractoryHFsymptomsPriororcurrentHFSymptomsStagesintheevolutionofHeartFailureABCDAHA/ACCHFguidelines2001ACE-i?blockersTreatrisk
5、factorsDietandexerciseAvoidtoxicsACE-iinselectedp.InselectedpatientsPalliativetherapyMech.AssistdeviceHeartTransplantACE-i?blockersDiuretics/DigitalisStagesintheEvolutionofHeartFailureTreatmentABCDAHA/ACCHFguidelines2001AggravatingFactorsMedicationsNewheartdiseaseMyocard
6、ialischemiaEndocarditisObesityHypertensionPhysicalactivityDietaryexcessPregnancyArrhythmias(AF)InfectionsThromboembolismHyper/hypothyroidismInitial/OngoingEvaluationIdentifyheartdiseaseAssessfunctionalcapacity(NYHA,6minwalk,…)Assessvolumestatus:(edema,rales,jugular,hepat
7、omegaly,bodyweight)Labassessment:routine:electrolytes,renalfunct.RepeatEcho,RXonlyifsignificantchangesinfunctionalstatusAssessprognosis8070605040302054-60>6050403020100PostMIn=196<3031-3536-4546-53Cardiac Mortality%LVEFBrodieB.etalAmJCardiol1992;69:1113PrognosisTreatment
8、ObjectivesSurvivalMorbidityExercisecapacityQualityoflifeNeurohormonalchangesProgressionofCHFSymptoms(Co
