Zhao Mingyao

BMC.ZZU.
2004-3-8
 The 10 Leading Causes of Death: United States, 2000

Diseases of the Heart 711

Cancers 553
Stroke 167

COPD 122
Unintentional Injuries 98

Diabetes Mellitus 69
Influenza & Pneumonia 65
Alzheimer's Disease 50
Nephritis & Nephrosis 37
Septicemia 31

0 100 200 300 400 500 600 700 800

Number of Deaths (in Thousands)
CDC. National Vital Statistics Report 2002; Vol 50, No. 15
1.What is the concept of heart
failure?
heart pump failure
myocardial failure
chronic congestive heart failure
 • Heart pump function

myocardial contractility
myocardial relaxility
SV preload (VR)
afterload
CO (ejection impedance)

Prolonged overload
HR metabolism structure change
2.Why is there heart failure with high-
output ?
3.Why doesn`t patient show obvi
ous sign and symptom in the e
arly stage of heart failure?

heart rate
frank-starling law
myocardial hypertrophy
blood volume and redistribution of blood
flow
• 4.What is compensatory
meaning of HR increased
in heart failure?
CO = SV X HR
 Frank-Starling law

Contractile power
Contractility
 Frank-Starling Curve
Body Intra-Thoracic
Total Blood Pressure
Volume Position

Atrial
Contribution
Stretch of Pericardial Pressure,
Compliance
Myocardium
Pumping Action of Venous
Skeletal Muscle Tone
Performance
Ventricular

End-Diastolic Volume
5.How many types of ventricle
hypertrophy are there in hea
rt failure?
concentric
eccentric
sarcomeres in parallel or in series
concentric eccentric
6.Why are there two side effects of he
art hypertrophy (myocardial remodel
ing )?
fibril, mit, vol ↑
but phenotype change, collagen(~ I, thick ,
stiff; ~III )
Myosin heavy chain MHC
α- MHC ↓,β- MHC↑
                                           

myocyte hypertrophy and widening of interstitial spaces due to de

postion of collagen, inflammatory cells and amyloid.
7.What are pathogenesis of heart
failure
myocardial contractility↓
decreased diastolic properties ↓
asymmetry and asynchronism in ventric
ular contraction and relaxation
8.How does myocardial
contractility decrease ?
myocardial injury
myocardial energy : production &
consumption
dysfunction of excitation-contraction
coupling ( Ca2+ delivery disorder )
 9.Why does insufficiency of
vitamin B1 lead to heart
failure?

~ decarboxylase
Pyruvic acid acetyl Co A

Krebs citric
ATP acid cycle
10.How does diastolic properties
of myocardium decrease ?
: loosing, cytosol Ca2+ , Ca2+ pump
compliance
diastolic load
Diastolic process = Relaxility

compliance
diastolic load
 11.What are the effects of heart failure
to body ?
myocardial contractility↓
heart pump↓
diastolic properties↓

CO ↓
VR↓pulmonary congestion
systemic congestion
? ?
?
12.What are the changes of cardiac functi
on during heart failure?

CO, CI, EF, LVEDP(V), PCWP,CVP

dp/dtmax, -dp/dtmax, Vmax
( T= π rP/h)
13.Why does left heart failure lead to
dyspnea?
14.How does orthopnea occur du
ring heart failure?

Orthopnea means shortness of br

eath while lying down.

                                                      
                                               

Orthopnea means shortness of breath while lying down.

15.What is mechanism of paroxy
smal nocturnal dyspnea ?
16.How to treat heart failure?
removal cause
prevent predisposing factor
improving cardiac function:
inotropic agent digitalis
Ca 2+ channel antagonist or Ca 2+ rec
eptor blocker
vasodilator agents
• Brief history about treating
heart failure:
1940 times heart + kidney mode
1970 times heart + circulation mode
1990 times heart + endocrine mode
ACEI, β-receptor blocker ,α- receptor
blocker
Belt long, life short, why?