Professional Documents
Culture Documents
EMERGENCY DEPARTMENT
Liu Chenyan
oxygen
trachea
arota
pulmonary artery
pulmonary
venous
left
ventricle
Cardiac Physiology
Adaptability
DO2=COCaO2
=SVHRCaO2
=EDVEFHRCaO2
oxygen demand
rest/sleeping
physical exercising
sepsis
Neurohormonal Modulation
Adaptive Mechanisms
Physiologic Mechanisms
Increase in SV
Increased SVR
Development of Cardiac Hypertrophy
Neurohormonal Modulation
Preload(EDP)
the filling volume
ventricular compliance
Frank-Starling mechanism
Increased preload improves SV
irrespective of the contractile state of the ventricle.
Afterload
HR and rhythmic
contraction
CO = HR SV
HR 150 ~ 160 bpm , CO
HR >160 bpm ,CO
cardiac natriuretic
peptides
DEFINITION
systolic dysfunction
diastolic dysfunction
other cardiac abnormalities, including
valvular disease, intracardiac shunting,
or arrhythmia
states in which the heart is unable to
compensate for increased peripheral
blood flow or metabolic requirements.
Pathphysiology and
Clinical Feature
pulmonary edem
systemic congestion
decreased tissue dyspnea
perfusion
edem
poor exercise
tolerance
dizzness,chronic
fatigue
tachycardia,diaphoresi
Evaluation
exercise torlerence
UCG
CR/CT
BNP
ABG
Pulmonary artery catheter(SwanGanz)
UCG
morpohologic change
LV,RV
functional change
LV Systolic function
LV Diastolic function
RV controversial?
hemodynamic information
SV,CO,PASP,HR
EDV
SV=EDV-ESV
EF=(EDVESV)/EDV
ESV
3.Diastolic dysfunction
E/A>1
EDT
19932ms
affected by preload,age and HR
Classfication of Diastolic
dysfunctionII type
III/IV type
I type
compliance
compliance
+relaxation
restrictive reversibl
ersible
E/A<1
E/A>1
E/A>2
EDT>220ms
EDT 150~220ms
EDT<150ms
CR
intersitial and
alveolar edema
with or without
cardiomegaly
CT
Kerley B
CT
ABG
hyoxemia
hypocapnia
CLASSIFICATION
Right-Sided
versus Left-Sided
Heart Failure
Systolic versus
Diastolic
Dysfunction
Acute versus
Chronic Heart
Failure
High-Output
versus LowOutput Failure
UCG
Left
Right
Manifestation of HF
left HF
right HF
congestive
HF
dyspnea
fatigue
dizziness
edema
edema
dyspnea
Left or Right
Left HF
RIGHT HF
Systolic or Diastolic
systolic dysfunction Diastolic
LVEF < 40%
dysfunction
failure of ventricular
LV dialation
relaxation with
consequent high
filling pressures
E/A>2
not with LV dialation
may exist in up to
The American Heart Association (AHA) and
half of older
American College of Cardiology (ACC)
individuals with HF
guidelines
UCG
hypofunction
EF
normal
mild decrease
moderate
decrease
value %
50~70
40~50
30~40
severe decrease <30
hyperfunction
volum deficit
dehydration massive haemorrhage
High-Output
anemia hyperthiorodism sepsis
Classfication of Diastolic
dysfunctionII type
III/IV type
I type
compliance
compliance
+relaxation
restrictive reversibl
ersible
E/A<1
E/A>1
E/A>2
EDT>220ms
EDT 150~220ms
EDT<150ms
Diastolic dysfunctionn
AMI
Hypertensive heart disease
HCM
RCM
Tips
Left HF
Right HF
systolic dysfunction
diastolic dysfunction
systolic dysfunction
hemodynamic change
pulmonary edem
systolic
dysfunction
Diastolic
dysfunction
LVEDP
High-Output or LowOutput
High-Output
CO
SVR
Low-Output
CO
SVR
BP = CO SVR
High-Output or LowOutput
Septic
anemia
Pregnancy
Thyroid
disorders
volum
deficit
High-Output
Low-Output
UCG
SEPSIS
High-Output
low-Output
Acute or Chronic
1.History
2.ventricular remodeling
3.Left+right
Acute or Chronic
Acute HF
Chronic
HF
AMI
massive PE
ischemic heart diease
rheumatic heart
disease
chronic cor pulmonale
congenital
cardiovascular disease
Evaluation of AHF
I. No evidence of HF
Evaluation of CHF
Diagnose of HF
Acute or Chronic
Left or Right
Systolic or Diastolic
High-Output or Low-Output
BNP+Tn
T
+ABG
UC
G
Left/Rig
ht
Systolic/Diasto
lic
Acute/Chronic
High-Output/LowOutput
CR/CT
ARDS?
morphologi
c diagnose
hemodynam
ic
information
etiolog
y
treatme
nt
congestive heart
failure
Pulmonary
embolus
AMI(RV)
Infection
Sodium and volume
excess
Pregnancy
Differenation of HF
cardiac
dyspnea
dependent
edema
asthma
AECOPD
ARDS
Cardiac tamponate
Constructive
pericardial
asthma
widespread bronchospasm(reversible)
not associated with exercising or position
ABG:hypercapnia
BNP:normal
UCG:RV dialation/pulmonary artery
hypertension
CT:emphysema
glucocorticoid
short-acting bronchodiator
CT
AECOPD
hypertension
CT:emphysema
short-acting bronchodiator
glucocorticoid
ARDS
CT
Cardiac tamponate
Cardiac tamponate
Constructive pericardial
thickend, fibrotic,adherent
pericardium that restricts diastolic
filling pressure
tuberculosis,radiation therapy or
cardiac surgery
UCG:a thick pericardium and small
chamber
CT:pericardial calcification
CT
TREATMENT OF AHF
case report 1
76y, male
chest comfort,dyspnea,
dizzness,weakness
worsen on supine position
hypertension
smoking
physical examination
uncomfortable,diaphoretic
BP90/62mmHg, HR112bpm R
26breath per minute, SPO293%
normal jugular venous
rales on both lung fields
tachycardia, no murmurs
ECG
ABG
Blood test
BNP elevated
UCG
CT
pulmonary edema
Diagnose
asthma
AECOPD
ARDS
PE
HF
Cardiac tamponate
case report 2
78y,female
productive cough,dyspnea,edema
worsen on supine position
COPD,OMI
physical examination
uncomfortable,diaphoretic
BP156/92mmHg, HR112bpm R
26breath per minute, SPO293%
normal jugular venous
wheels on both lung fields
tachycardia, systolic murmur on
apex
ABG
Blood test
BNP elevated
UCG
CT
Diagnose
asthma
AECOPD
ARDS
PE
HF
Cardiac tamponate
answer
case1 HF
case2 HF,AECOPD
Thanks