心脏衰竭
Marco Metra1, John R Teerlink2
1Institute of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.
Lancet (London, England)
|May 3, 2017
概括
心力衰竭的治疗正在得到改善,新的药物如血管激素受体尼普利辛抑制剂 (RNAI) 显得有前途. 然而,心力衰竭的有效治疗方法仍然难以捉摸,这凸显了未满足的临床需求.
科学领域:
- 心脏病学
- 内部医学
背景情况:
- 由于人口老龄化和急性心血管事件管理的改善,心力衰竭 (HF) 是一个全球性的健康问题.
- 虽然存在心力衰竭降低射出分数 (HFrEF) 的治疗方法,如ACE抑制剂,ARB,β- 阻断剂和RNAI,但仍有大量未满足的需求,特别是心力衰竭保留射出分数 (HFpEF).
研究的目的:
- 审查目前心力衰竭的治疗策略,重点关注进展和剩余的挑战.
- 突显RNAI和左心室辅助器件 (LVAD) 等疗法的不断变化的作用.
- 讨论HFpEF有限的治疗选择以及需要新的治疗方法.
主要方法:
- 对心力衰竭流行病学,病理生理学和治疗疗效的当前文献的综述.
- 对药物和基于设备的治疗指南的分析.
- 对HFrEF和HFpEF新药机制的正在进行的研究进行审查.
主要成果:
- 与埃纳拉普利尔相比,血管素受体抑制剂 (RNAI) 的治疗结果有所改善,因此建议在HFrEF中使用它们.
- 由于安全性提高,左心室辅助器件 (LVAD) 越来越多地用于严重的HF.
- 尽管有一些关于螺旋的证据,但对于HFpEF没有明确的治疗方法.
结论:
- 虽然HFrEF治疗的进展,包括RNA和LVAD,正在改善患者的治疗结果,但HFpEF仍然是一个治疗挑战.
- 包括心肌激活剂在内的新药开发对于解决HFrEF和HFpEF未满足的需求至关重要.
- 为了为日益增长的心力衰竭患者开发有效的治疗方法,
相关概念视频
01:27Heart Failure I: Introduction
1.1K
Heart failure refers to a clinical syndrome caused by structural or functional cardiac disorders that prevent the heart from pumping an adequate amount of blood to meet the body's metabolic needs. This condition often arises from myocardial infarction or ischemia, leading to decreased cardiac output, reduced tissue perfusion, impaired gas exchange, fluid volume imbalance, and decreased functional ability.Heart failure can result from disruptions in the mechanisms that regulate cardiac output...
1.1K
01:17Pathophysiology of Heart Failure
4.2K
Heart failure (HF) is a progressive syndrome involving ventricles that leads to inadequate cardiac output. It can be classified based on location and output or ejection fraction. Ejection fraction (EF) is an essential measurement in the diagnosis and surveillance of HF. Reduced EF corresponds to systolic heart failure (HFrEF). However, HF with preserved ejection fraction (HFpEF) is becoming increasingly prevalent. Also known as diastolic HF, this form of HF is related to aging. The...
4.2K
01:26Imbalances in Cardiac Output
3.3K
The heart's primary function is to pump blood throughout the body, maintaining a balance between blood sent out (cardiac output) and blood returning (venous return). If this balance is disrupted, it can result in congestive heart failure (CHF), a severe condition where the heart becomes an inefficient pump, leading to inadequate blood circulation.
CHF can occur due to the failure of either side of the heart. Left-side failure leads to pulmonary congestion—the right side continues to send...
CHF can occur due to the failure of either side of the heart. Left-side failure leads to pulmonary congestion—the right side continues to send...
3.3K
01:26Heart Failure III: Clinical Manifestations
722
Heart failure (HF) manifests primarily as dyspnea, fatigue, and fluid retention, resulting in peripheral and pulmonary edema. Symptoms may vary depending on which ventricle is more affected, left or right.Left-Sided Heart FailureAlso known as left ventricular failure, this condition results from the left ventricle's inability to fill or eject sufficient blood into the systemic circulation. It leads to pulmonary congestion, which occurs when the left ventricle fails to eject blood effectively...
722
01:30Heart Failure IV: Classification and Diagnostic Evaluation
491
Heart failure can be classified in various ways, with the most common classifications based on physical activity limitations, disease progression, severity, and treatment strategies.The Functional Classification of Heart Failure divides patients into four categories based on physical activity limitation due to symptom burden.Class I: Patients in this class have cardiac disease but no physical activity limitations. Ordinary activities like walking, climbing stairs, or routine tasks do not cause...
491
01:29Heart Failure II: Pathophysiology
1.1K
Systolic Heart Failure and Compensatory MechanismsSystolic heart failure (also termed HFrEF, Heart Failure with Reduced Ejection Fraction) is the most prevalent type of heart filure. It results in a decreased volume of blood being pumped from the ventricle. The aortic arch and carotid sinuses have baroreceptors that detect reduced blood pressure, triggering the sympathetic nervous system (SNS) to release epinephrine and norepinephrine. Initially, this response aims to boost heart rate and...
1.1K