כל החומר על הלב - ברונר

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1 (' 987) ,HF )congestive heart failure )CHF . CHF , : . - HF . )cardiac output )CO . HF HF . HF myocardial heart disease ( (systolic dysfunction ( (diastolic dysfunction ( ( . HF . , . HF ( ) . CHF " . HF Chronic heart failure - ( CAD ) - - HF . , CAD . HF " HF . outpatient care - HF . , . HF 2 HF . Diastolic heart failure . Systolic heart failure . - , ejection fraction HF . ejection fraction : % % % " . - Diastolic heart failure ejection fraction - Systolic heart failure ejection fraction -%04 . - HF : Class I class IV . (' 397) - HF -, : , , . . HF Systolic heart failure . . . , down regulation 1 . " : ( I ) II. I II . ACE II vasoconstrictor . . . , , - : ANF , endothelin-prostacyclin : Afterload , . Preload . . , - myofibrils -end diastolic volume ((EDV, ( (myofibrils (.(ventricular dilation .

(Heart failure (HF

2 . , . , - stress . , . CAD ":"vicious cycle of HF , "" . , . Diastolic heart failure , , ( ), , . - ,CO - CO , - - .systolic HF , CAD , cardiomyopathy. . - CAD - . HF -%06 . CAD . MI ( ) . , . - revascularization " PCI " - underlying cause . - 3 : Dilated , (.)systolic failure dilated ( ) , ( myocarditis . , )HF ( adriamycin ) Hypertrophic- restrictive cardiomyopathy (. )diastolic heart failure " - . , - . . . - , afterload . . - . HF ( ) . , , , ( ). - : HF - , BMR , ( -%52) . - . CO , . - HF HF , Dysrhythmia . ( ) , , . , , . : : , apical impulse 3 , S , , -.)jugular )JVD : Cerebrovascular , . , , , , . : , . : dyspnea , , orthopnea - : ( )paroxysmal nocturnal dyspnea .

3 : ( ) Diastolic heart failure , Systolic heart failure . ? . , . - chronic HF . , ventricular ectopic beats - AV HF ( HF , . )digitalis , . - EDV , End systolic pressure . , . , , . . backward failure : , , , 3 S " . ( ) . (orthopnea ) , PND -PND , . . . COPD . " ( ). : bi-basilar " . , . () . , , - .forward failure . - CO , . ( )SV . ( . )oliguria , . ( ). , , . ( . (nocturia - CO . . , . . , . , " " ( ) . CO , , . , , . ( ( . " . ' (.)JVD , , , JDV , , , ( ) . " , ( ) . . , . , . - . sacral

4 Pitting edema 5.4 " . * pitting edema , " . . , . . . - . secondary liver dysfunction , , , . - ( - ). , . . , . - , CO . -.CHF , , , .COPD , . CHF . HF CHF HF ( ). . - - , underlying cause ejection fraction - . HF Radionuclide ventriculography " ventriculogram . - ECG - underlying cause -. HF , , ( , )BUN , , BNP , TSH Complete Blood cell Count . underlying cause baseline . exercise test CAD (. )HF )acute myocardial infraction )MI , . HF ( )HF MI , , inferior MI ( 4-2 ) , Q -ECG . - HF , . HF - . HF . HF : , . " - . afterload + preload HF , , , . . . endotracheal intubation . - underlying cause CAD ( PTCA )revascularization . , . Cardiac resynchronization left ventricular + biventricular HF . ( LBBB - bundle ) . LBBB - pulse -2 - bundle + , . , - . ejection fraction lead 2 .

5 -%36 , . - . systolic HF - diastolic HF - underlying cause .. . , " . ACE ( ACE ) )II )ARB Hydralazine- . isosorbide dinitrate . ACE .digitalis ,HF . Spironolactone . ( ACE )pril . , HF . . II . ACE " afterload- preload" . , . ACE , . ACE . ACE , . ACE , , . . " , , . ACE : , - , , . , ACE 57 , - 001 , mmHg -531 mEq/L . - . ACE ACE , , . ( , ) . ACE -. 5 mEq/L 3 mg/dL ACE. ACE . . . angioedema - angioedema - oropharyngeal - . ACE ( II (II ()losartan ACE II : . ACE > I II , II II . : , , . II " .ACE Hydralazine- isosorbide dinitrate .ACE ( Nitrate )isosorbide dinitrate -.preload Hydralazine - afterload. - Hydralazine -.nitrate : carvedilol , metoprolol , bisoprolol ACE

6 II- III" . - MI revascularization . HF . HF " . : , -. bradycardia , . ACE , . , ???? ( ) , . ??? , , , ACE . . . , I metoprolol : - . . . . HF : . thiazide , loop , potassium sparing " . Thiazide metolazone .Early distal tubules loop furosemide . () . Thiazide . Loop . ( thiazide- )loop ( )severe HF . ( -2 ) ( -2 ). Spironolactone potassium sparing - . late distal tubule + collecting duct III IV potassium sparing ACE , loop , (. )HF " 4 . potassium sparing : , ( ) , ( hyperuricemia ) - . ototoxicity , . . . Digitalis - digitalis HF . ( )AV ( ). - output . . , . (. )ADL HF II + III .

7 . , , , - blocks- SA- AV , , . -)digoxin immune FAB ) digibing . . : , , , . . , , . , , , , . verapamil diltiazem ( ). Amlodipine , felodipine , dihydropyridine . , . . - - underlying cause . HF NSAIDS ibuprophen , . - ( decongestants ). ( -2 ) . , . . . / . . . : . . . 2-1 5 . . - JVD - . dependent edema . . : , PND . . . , , , , . - HF . , . + digitalis . , . ACE II- . spironolactone

8 , , , . : ( hyperuricemia ) , , . ( ) , , , . , . . - urethra . " - suprapubic . HF - HF . , , . , HF . . , ADL . - HF , . - , HF . . . / ( ) . . 3 , S , . . SA , () . JVD , 3 " - sternum . .CVP . . . , , . . - sacrum . . , HF . : hepatojugular reflux 06-03 . 1 " . , ( )baseline . in/out , ( ) . ( )oliguria -004 anuria -05 . ( ") . ( 2-1 5 ) ( ). , - HF : ( - CO ). HF .

9

. . . / , : Thromboembolism . Pericardial effusion and cardiac tamponade

, , , , . (((acute heart failure ( . . . HF , MI . , . , . " , "flash pulmonary edema . , . , . . , . . , , (). , . ( ) . , . , - , HF preload , afterload , -.CO impedance cardiography . , . , , (). . JVD . , . , , . . . . " .