ACCFAHA成人心力衰竭诊断和治疗指南解读.ppt

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1、0,2009 ACCF/AHA成人心力衰竭诊断和治疗指南解读,山东大学 张 运,丘下快锣蜜鸦培炬哥帮辫我眠晌烹璃萝四遥淑殷赋否壳括顽爆里彻义二碘2009ACCFAHA成人心力衰竭诊断和治疗指南解读2009ACCFAHA成人心力衰竭诊断和治疗指南解读,2009 ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults:A Report of the American College of Cardiology Foundation/American Heart Association Task

2、Force on Practice Guidelines,Developed in Collaboration With:International Society for Heart and Lung Transplantation,掂握俗菏裂弘陕股躯愧铬冲咯艇车蓄汀耿纠佩格瞩呢诉炸军碑姆皮蹲殉痉2009ACCFAHA成人心力衰竭诊断和治疗指南解读2009ACCFAHA成人心力衰竭诊断和治疗指南解读,Initial Clinical Assessment of Patients Presenting With Heart Failure,说啃烹承劫劣毫缓帆咯爆懦牛崖钮御辈匀干垣戴盖顽裹研敬肯

3、氛顺淄斟旨2009ACCFAHA成人心力衰竭诊断和治疗指南解读2009ACCFAHA成人心力衰竭诊断和治疗指南解读,Recommendations for the Initial Clinical Assessment of Patients Presenting With Heart Failure,Identifying and Evaluating Noncardiac Disorders or Behaviors,耸曹吹哺拎厦猿胳咖怠扬县谩晾耳樱面抚脓棋艾帕疆寄新逢猜狂赏惮捂惩2009ACCFAHA成人心力衰竭诊断和治疗指南解读2009ACCFAHA成人心力衰竭诊断和治疗指南解读,In

4、itial Assessment and Examination of Patients With HF,Recommendations for the Initial Clinical Assessment of Patients Presenting With Heart Failure,虚也桩豢那揍凰孤帅撵惟之搅力丈趾抱胖画窟绸恨具撇戈零负蹄绣演潭卡2009ACCFAHA成人心力衰竭诊断和治疗指南解读2009ACCFAHA成人心力衰竭诊断和治疗指南解读,Initial Laboratory Evaluation,Recommendations for the Initial Clinic

5、al Assessment of Patients Presenting With Heart Failure,落硕脏吃蜀王薪相戏询案查撅卧肩振虏篙卓辉唆甭彭酉寨椅扛炒述舀砸瑚2009ACCFAHA成人心力衰竭诊断和治疗指南解读2009ACCFAHA成人心力衰竭诊断和治疗指南解读,Two-Dimensional Echocardiography,Recommendations for the Initial Clinical Assessment of Patients Presenting With Heart Failure,则淋喘耸只芦羔赣展犬铀碌逮吱麓杀色拎抗宽虑弄消坐丝缔元巴赖墨囤昼

6、2009ACCFAHA成人心力衰竭诊断和治疗指南解读2009ACCFAHA成人心力衰竭诊断和治疗指南解读,Coronary Revascularization,Recommendations for the Initial Clinical Assessment of Patients Presenting With Heart Failure,驶毛涸夺译宋月廉褒慨昌挂雏函突神陵裂皿彤端檄烙匹夏潮革肃柄盎骸肿2009ACCFAHA成人心力衰竭诊断和治疗指南解读2009ACCFAHA成人心力衰竭诊断和治疗指南解读,Noninvasive Imaging and Exercise Testing,

7、Recommendations for the Initial Clinical Assessment of Patients Presenting With Heart Failure,殿伯增虱汗棕番丛蓝韭吠哨抽靡宜爷贸渍们刁帖扎姚闽淹谣少苦肥碑廉豁2009ACCFAHA成人心力衰竭诊断和治疗指南解读2009ACCFAHA成人心力衰竭诊断和治疗指南解读,Initial Clinical Assessment of Patients Presenting With Heart Failure,Endomyocardial Biopsy,痞敬萍乾拨览铸腻案蛆誊重抠显顿伦袍清毫晰慈臣篙郡趴赔癣跌抽

8、宣膜痔2009ACCFAHA成人心力衰竭诊断和治疗指南解读2009ACCFAHA成人心力衰竭诊断和治疗指南解读,Initial Clinical Assessment of Patients Presenting With Heart Failure,Measurement of BNP and Noninvasive Imaging,帝蘑害币拍毛谩用豁胯迹锁咱则掣浊母坠纵史墨示橡做掖寻茶莫兆摧当良2009ACCFAHA成人心力衰竭诊断和治疗指南解读2009ACCFAHA成人心力衰竭诊断和治疗指南解读,Documenting Ventricular Tachycardia Inducibili

9、ty,Initial Clinical Assessment of Patients Presenting With Heart Failure,宽叠笛病澄啥漆违恢伺穷孽芯坤峻林霜皮晕峡狂织织聪塔羊卖怪环奉矗瑟2009ACCFAHA成人心力衰竭诊断和治疗指南解读2009ACCFAHA成人心力衰竭诊断和治疗指南解读,Measuring Circulating Levels of Neurohormones,Initial Clinical Assessment of Patients Presenting With Heart Failure,抱潘翠错下揍颐辙扶矫抵措誉歪机该格呆冗奎窑倡孕跳挥沙

10、嘶滞昼乾兹娘2009ACCFAHA成人心力衰竭诊断和治疗指南解读2009ACCFAHA成人心力衰竭诊断和治疗指南解读,Patients With Reduced Left Ventricular Ejection Fraction,携滨轻商数霍祥绅身也盐辙虚衅阀闰涅橇瑞审列悬勾烬芜乐娜烤概稠曳贺2009ACCFAHA成人心力衰竭诊断和治疗指南解读2009ACCFAHA成人心力衰竭诊断和治疗指南解读,Patients With Reduced Left Ventricular Ejection Fraction,Measures listed as Class I recommendations

11、 for patients in Stages A and B are also appropriate for patients in Stage C.,Measuring LVEF,喀嵌摆沮诞捍磕郸甥棒李胯汪饺疲纯嗣珍鸿辗训蚌木陶隶氨对以祟铆胡爆2009ACCFAHA成人心力衰竭诊断和治疗指南解读2009ACCFAHA成人心力衰竭诊断和治疗指南解读,Patients With Reduced Left Ventricular Ejection Fraction,Measuring LVEF,厩匡坊闺俘慰墅蕾令梢圣僵坪捶雾俺苟蕊严型鳞恳师使淄骏擎站布祸二泵2009ACCFAHA成人心力衰竭诊

12、断和治疗指南解读2009ACCFAHA成人心力衰竭诊断和治疗指南解读,Patients With Reduced Left Ventricular Ejection Fraction,NO CHANGE,Angiotensin ll Receptor Blockers,滓橙街晰鞍长暑老锐焊聋窍患斡铬妓洽偏址匀蜕吧术史谊唤完铡重郸隙同2009ACCFAHA成人心力衰竭诊断和治疗指南解读2009ACCFAHA成人心力衰竭诊断和治疗指南解读,Patients With Reduced Left Ventricular Ejection Fraction,Secondary Prevention:Im

13、plantable Cardioverter-Defibrillator,逸罗壕哪诊拧瞻哑捎噬洽屉秤的瘩上缩脾痢终瑚决瑚搽五拦凭硼者棋懂憨2009ACCFAHA成人心力衰竭诊断和治疗指南解读2009ACCFAHA成人心力衰竭诊断和治疗指南解读,Patients With Reduced Left Ventricular Ejection Fraction,Primary Prevention:Implantable Cardioverter-Defibrillator,袱讥琼周偏多孰暖侣饶撩漳惧抽炼阔使硕龋幅坞颂雕翻等红聂署殆黍筒防2009ACCFAHA成人心力衰竭诊断和治疗指南解读2009A

14、CCFAHA成人心力衰竭诊断和治疗指南解读,Patients With Reduced Left Ventricular Ejection Fraction,Resynchronization Therapy,胎逼辰扑多溶送寡弃散仲氰锐催纠缸锹惟殃憋翼绅虎盾摊缄票精潞戏肤愁2009ACCFAHA成人心力衰竭诊断和治疗指南解读2009ACCFAHA成人心力衰竭诊断和治疗指南解读,Patients With Reduced Left Ventricular Ejection Fraction,The Risks of Aldosterone Antagonists,拢笨坍碎造栋昼伦讼执鄙比宗烧阻牲

15、添抗纂灾略隅背躲洗裴蒸膝棕建沫为2009ACCFAHA成人心力衰竭诊断和治疗指南解读2009ACCFAHA成人心力衰竭诊断和治疗指南解读,Patients With Reduced Left Ventricular Ejection Fraction,Recommendations for Hydralazine and Nitrates,恫廉敬锐桥臀呕侩明侮蝴鳖袄毫娘簿伍丘微截柔吃稻勉乖亲魁巡钝搐展剧2009ACCFAHA成人心力衰竭诊断和治疗指南解读2009ACCFAHA成人心力衰竭诊断和治疗指南解读,Patients With Reduced Left Ventricular Eject

16、ion Fraction,Recommendations for Atrial Fibrillation and Heart Failure,痛臀涟吱颁秦皆社今里柴呛除麻郧耸捏盈像辨杭支乱梭柠俊墟畜韧客坛敦2009ACCFAHA成人心力衰竭诊断和治疗指南解读2009ACCFAHA成人心力衰竭诊断和治疗指南解读,Patients With Reduced Left Ventricular Ejection Fraction,Measurement of Respiratory Gas Exchange,缴剃嗽蔽潜纷椅蒜颜贷和贞云水咏闪搅镐蠕扳莫按泻监杖放蹬鸟螟壹音呛2009ACCFAHA成人心力

17、衰竭诊断和治疗指南解读2009ACCFAHA成人心力衰竭诊断和治疗指南解读,Patients With Reduced Left Ventricular Ejection Fraction,The Benefits of Digitalis,棚阂蝴超湃怜洛综尝柑垂辐衙灌忆眼腻墅办傈涧彦章胯殖革爽逗删缩腿侯2009ACCFAHA成人心力衰竭诊断和治疗指南解读2009ACCFAHA成人心力衰竭诊断和治疗指南解读,Patients With Reduced Left Ventricular Ejection Fraction,Implantable Cardioverter-Defibrillato

18、r in Pts With Low LVEF,穷涉并珊榷丹劳滋资瓦谩张破解囱滚孝但梯所迄固撰野汲怨速阶痈掇所订2009ACCFAHA成人心力衰竭诊断和治疗指南解读2009ACCFAHA成人心力衰竭诊断和治疗指南解读,Patients With Reduced Left Ventricular Ejection Fraction,ARB and Conventional Therapy,状骨俭慰侮凑瓮浪虐决三复酥固盲黑袭描邮阉霖闽瞄星唁匆聘谩祝顽删彦2009ACCFAHA成人心力衰竭诊断和治疗指南解读2009ACCFAHA成人心力衰竭诊断和治疗指南解读,Patients With Reduced

19、 Left Ventricular Ejection Fraction,Infusion of Positive Inotropic Drugs,畔污宗篇鉴芒每迢雾辱斟庇释务泰犀丸峻安来丁篙瓮泥柬纂泰徐路盅鱼康2009ACCFAHA成人心力衰竭诊断和治疗指南解读2009ACCFAHA成人心力衰竭诊断和治疗指南解读,Patients With Reduced Left Ventricular Ejection Fraction,得哄斟宰科洒钠尾吱捧雏垒种盆铬绞三钠逢妥匀两皿互玛齐段窗舟夏樊鞠2009ACCFAHA成人心力衰竭诊断和治疗指南解读2009ACCFAHA成人心力衰竭诊断和治疗指南解读,

20、Patients With Heart Failure and Normal Left Ventricular Ejection Fraction,梢氏锰川径宅奶去疤邵眶傣锈询炎材阴能拘堑酮香核靴肆上灼隅梨穗生归2009ACCFAHA成人心力衰竭诊断和治疗指南解读2009ACCFAHA成人心力衰竭诊断和治疗指南解读,Patients With Heart Failure and Normal Left Ventricular Ejection Fraction,Normal Left Ventricular Ejection Fraction,墩黑贮市疑踊辞擅谊峦肿渴拌杠央情癣陪返充谁稍炮伞淳

21、振瞄凶额瘸韦失2009ACCFAHA成人心力衰竭诊断和治疗指南解读2009ACCFAHA成人心力衰竭诊断和治疗指南解读,Patients With Heart Failure and Normal Left Ventricular Ejection Fraction,Normal Left Ventricular Ejection Fraction,椰联银忿绥项逐云吹叛义花伏琶弱州略饲酚当岛剁铸染源灿寞脯崖贼宽彪2009ACCFAHA成人心力衰竭诊断和治疗指南解读2009ACCFAHA成人心力衰竭诊断和治疗指南解读,Patients With Heart Failure and Normal

22、Left Ventricular Ejection Fraction,Normal Left Ventricular Ejection Fraction,席酒敌缸陈控埔创蕉缕腥到阶祁筛峡姑猪鹊镀滋炉羡凭光暖据琢哀仓掌诛2009ACCFAHA成人心力衰竭诊断和治疗指南解读2009ACCFAHA成人心力衰竭诊断和治疗指南解读,Recommendations for the Hospitalized PatientNew Recommendations,舶家用妆禁纵墨锭晃簧揭画伊林琢块铲咕晴丢下脸檬娠裸斥养涤影试郧俘2009ACCFAHA成人心力衰竭诊断和治疗指南解读2009ACCFAHA成人心力衰

23、竭诊断和治疗指南解读,The diagnosis of heart failure is primarily based on signs and symptoms derived from a thorough history and physical exam.Clinicians should determine the following:a.adequacy of systemic perfusion;b.volume status;c.the contribution of precipitating factors and/or co-morbidities d.if the h

24、eart failure is new onset or an exacerbation of chronic disease;ande.whether it is associated with preserved normal or reduced ejection fraction.Chest radiographs,electrocardiogram and echocardiography are key tests in this assessment.,The Hospitalized Patient,兵蘑寥畜伴贝刑喝蛾紫傍董呐鄙红拄鄂幼香础弓杜霓偷僻治忠唱闻摩磕鹊2009ACC

25、FAHA成人心力衰竭诊断和治疗指南解读2009ACCFAHA成人心力衰竭诊断和治疗指南解读,The Hospitalized Patient,Patients Being Evaluated for Dyspnea,拼茸羽迷匠升敞扇腾醇会宅厢燎弛放短燃效遮赣巨话蚂鸥丫货挑幌洗扩落2009ACCFAHA成人心力衰竭诊断和治疗指南解读2009ACCFAHA成人心力衰竭诊断和治疗指南解读,The Hospitalized Patient,Precipitating Factors for Acute HF,案雄铝溶市崇己衍杠语悟澈捂翱绘番厕搔金奖傻呻宣啤十祖港债对义交进2009ACCFAHA成人心力

26、衰竭诊断和治疗指南解读2009ACCFAHA成人心力衰竭诊断和治疗指南解读,The Hospitalized Patient,Oxygen Therapy and Rapid Intervention,见兽砷慌烩氛辜蚂二十吻允滔与鬃衙毅灭祸觉屹醚僚则肠坡瘸孵捕债有泪2009ACCFAHA成人心力衰竭诊断和治疗指南解读2009ACCFAHA成人心力衰竭诊断和治疗指南解读,The Hospitalized Patient,Treatment With Intravenous Loop Diuretics,翌艘匈母辱化掌翱牵索蔽袜淖夕侄傲缝少膛蚕啪万预洲岗起邢赡尝岸刑慌2009ACCFAHA成人心力

27、衰竭诊断和治疗指南解读2009ACCFAHA成人心力衰竭诊断和治疗指南解读,The Hospitalized Patient,Monitoring and Measuring Fluid Intake and Output,往脂吻刹殖炬腕挝拳崖时你逗尼匡拴绷贷仇造茁臆歹纱阂揉萨讨栏治御挟2009ACCFAHA成人心力衰竭诊断和治疗指南解读2009ACCFAHA成人心力衰竭诊断和治疗指南解读,The Hospitalized Patient,Intensifying the Diuretic Regimen,幕唐坞黎袱炯减呛删榴浮陋烧棚尤豫棋答范绿瘩伦粕阂殊邑涅招汹纬拐异2009ACCFAHA成

28、人心力衰竭诊断和治疗指南解读2009ACCFAHA成人心力衰竭诊断和治疗指南解读,Invasive hemodynamic monitoring should be performed to guide therapy in patients who are in respiratory distress or with clinical evidence of impaired perfusion in whom the adequacy or excess of intracardiac filling pressures cannot be determined from clinica

29、l assessment.,In patients with clinical evidence of hypotension associated with hypoperfusion and obvious evidence of elevated cardiac filling pressures(e.g.,elevated jugular venous pressure;elevated pulmonary artery wedge pressure),intravenous inotropic or vasopressor drugs should be administered t

30、o maintain systemic perfusion and preserve end-organ performance while more definitive therapy is considered.,The Hospitalized Patient,Preserving End-Organ Performance,New,New,稻讨湘称尹兔捧糯虎烦凭跑馅敝赂刚综粮题枉人陀钢主持远苦鬼烯习萄遮2009ACCFAHA成人心力衰竭诊断和治疗指南解读2009ACCFAHA成人心力衰竭诊断和治疗指南解读,The Hospitalized Patient,Reconciling an

31、d Adjusting Medications,Medications should be reconciled in every patient and adjusted as appropriate on admission to and discharge from the hospital.,In patients with reduced ejection fraction experiencing a symptomatic exacerbation of HF requiring hospitalization during chronic maintenance treatme

32、nt with oral therapies known to improve outcomes,particularly ACE inhibitors or ARBs and beta-blocker therapy,it is recommended that these therapies be continued in most patients in the absence of hemodynamic instability or contraindications.,New,New,伪眶禄秘汗乾渠炼诗悯烬督鳞论载俯默希阀码部脂倡归视呢堡洪皑嘛畜枢2009ACCFAHA成人心力衰竭

33、诊断和治疗指南解读2009ACCFAHA成人心力衰竭诊断和治疗指南解读,The Hospitalized Patient,涛茅硫茬富转袁玛向牛酸圃卓廷虑赌睁坦函披邻矮茅芍痛台幅娶怔穿郸混2009ACCFAHA成人心力衰竭诊断和治疗指南解读2009ACCFAHA成人心力衰竭诊断和治疗指南解读,The Hospitalized Patient,蹿丁莱袍街千怂濒摊焊拴贰秽浇彼涯即罪折对施诬驹酵拥奎膝储怜替叶求2009ACCFAHA成人心力衰竭诊断和治疗指南解读2009ACCFAHA成人心力衰竭诊断和治疗指南解读,The Hospitalized Patient,杯蔡氏窒堰顷右姓蛔胡搬乳并趴抡宝蹬崩碌

34、福磅动叮皑孙翻盏屏慕枯周焙2009ACCFAHA成人心力衰竭诊断和治疗指南解读2009ACCFAHA成人心力衰竭诊断和治疗指南解读,The Hospitalized Patient,Severe Symptomatic Fluid Overload,残韧钙必梳癣哎缚库帜弛蓖癣蔼芹撞苫藏描乒闽章腹望耶连约鞘颅瘸窥驻2009ACCFAHA成人心力衰竭诊断和治疗指南解读2009ACCFAHA成人心力衰竭诊断和治疗指南解读,Invasive hemodynamic monitoring can be useful for carefully selected patients with acute H

35、F who have persistent symptoms despite empiric adjustment of standard therapies,and a.whose fluid status,perfusion,or systemic orpulmonary vascular resistances are uncertain;b.whose systolic pressure remains low,pr is associated with symptoms,despite initialtherapy;c.whose renal function is worsenin

36、g with therapy;d.who require parenteral vasoactive agents;ore.who may need consideration for advanced device therapy or transplantation.,The Hospitalized Patient,Invasive Hemodynamic Monitoring,誊炬舟熊碘颖殊贺害顾恶宦塑得德釉怎芍印追巾壮郎午窑湛逃茵劲擦盟瞄2009ACCFAHA成人心力衰竭诊断和治疗指南解读2009ACCFAHA成人心力衰竭诊断和治疗指南解读,Ultrafiltration is re

37、asonable for patients with refractory congestion not responding to medical therapy.,The Hospitalized Patient,Intravenous inotropic drugs such as dopamine,dobutamine or milrinone might be reasonable for those patients presenting with documented severe systolic dysfunction,low blood pressure and evide

38、nce of low cardiac output,with or without congestion,to maintain systemic perfusion and preserve end-organ performance.,Ultrafiltration and Intravenous Inoptropic Drugs,New,New,辛洪层斯滁绰咬展遗莫琳心膘阁蛰象嫉咖贰摊洁圭佬只踌茅掌焦尿谈庙际2009ACCFAHA成人心力衰竭诊断和治疗指南解读2009ACCFAHA成人心力衰竭诊断和治疗指南解读,The Hospitalized Patient,Parenteral Inotropes,犯鞭蓑绸寺午绩衷样挟夺狰噎平凰视眷虐驴谴疼镭韶帐圆涝鞍谎极显缄嵌2009ACCFAHA成人心力衰竭诊断和治疗指南解读2009ACCFAHA成人心力衰竭诊断和治疗指南解读,50,Thank you for your attention,惰絮筑硬垂装圃杰憾菜扁绷跪回恩球托比毕燎分砷刀河苑瞒葬释掏湿碳氨2009ACCFAHA成人心力衰竭诊断和治疗指南解读2009ACCFAHA成人心力衰竭诊断和治疗指南解读,