心功能不全——是指各种病因导致心脏舒缩功能受损或心室血液充盈受限，在有足够循环血量的情况下，使心排出量减少，以致不能满足机体代谢需要，出现全身组织器官灌流不足，肺循环和体循环静脉淤血的病理过程。

心力衰竭——是指心功能不全的失代偿阶段，两者在本质上是相同的，可以通用。

充血性心衰——慢性心衰时，常伴有血容量及组织间液代偿性增多及体循环和（或）肺循环静脉系统淤血、水肿。

Left heart: hypertension, aortic stenosis

Right heart: cor pulmonale, pulmonary stenosis

Left heart: mitral valve, aortic valve regurgitation

Right heart: tricuspid valve, pulmonary valve insufficiency

atrial septum, ventricular septal defect

Whole heart: inflammation anemia, hyperthyroidism, vitamin B1 deficiency, arteriovenous fistula, etc.

Increased cardiac preload

Sympathetic nerve excitement increases myocardial contractility and increases the burden on the heart.

Coronary heart disease, hypertension ---> Pulmonary circulation congestion --> Pulmonary edema, dyspnea

COPD, pulmonary embolism ---> systemic circulation congestion --> edema, jugular venous distension, hepatomegaly

Lesions invade both left and right ventricles simultaneously

Left heart failure leads to increased pulmonary circulatory resistance

Acute heart failure refers to a clinical syndrome in which sudden onset or acute exacerbation of original chronic heart failure results in reduced myocardial contractility and increased cardiac load, resulting in an acute sudden drop in cardiac output and tissue congestion. Clinically, acute left heart failure is the most common, most manifesting as systolic heart failure, but may also manifest as diastolic heart failure, which is often life-threatening.

Give inotropes

Give CCB drugs

Level II - Asymptomatic at rest, limited physical activity and movement

III-Asymptomatic at rest, but limited sensation during mild activities

IV-resting also has symptoms

Commonly seen in heart failure caused by coronary heart disease, hypertension, heart valve disease and myocarditis

Mainly seen in severe anemia, pregnancy, hyperthyroidism, arteriovenous fistula and vitamin B1 deficiency, etc.

Even if cardiac insufficiency develops, the patient's cardiac output is still higher or not lower than the average level of the normal population

Benefits: Improve heart pumping function; redistribute blood in systemic circulation. (Mainly vasoconstriction of the skin, skeletal muscles, kidneys and abdominal organs, and vasodilation of the heart, brain and other important organs) Disadvantages: Increase myocardial oxygen consumption, increase before and after load, induce arrhythmia, and promote myocardial cell remodeling

Decreased cardiac output activates baroreceptors in the jugular sinus and aortic arch, which in turn activates the sympathoadrenal medullary system

Improve heart pumping function

Visceral resistance vasoconstriction Venous vasoconstriction Increases blood flow to the heart

Benefits: Directly constrict blood vessels, increase renal perfusion, and maintain circulating blood volume

Disadvantages: Increased myocardial preload and postload, water and sodium retention, increased ventricular filling pressure, resulting in myocardial cell remodeling

Natriuretic and potassium excretion, dilation of blood vessels, inhibition of renin and aldosterone systems

increased heart rate

myocardial tensogenic dilation

Increased myocardial contractility

cardiomyocyte remodeling

myocardial interstitial remodeling

Benefits: Increase cardiac output and tissue perfusion Disadvantages: Increased cardiac load leading to ventricular remodeling

Sympathetic nervous excitement

RAAS system activation

Increased ADH release

Decreased synthesis of PEG2 and ANP, promoting water and sodium excretion

Benefits: Guaranteed blood supply to important organs such as the heart and brain Disadvantages: decreased organ function, increased cardiac afterload, and decreased cardiac output.

Sympathetic nerve excitement leads to selective contraction of peripheral blood vessels, most notably in the kidneys

Cardiac insufficiency-->Circulating hypoxia-->Increased bone hematopoietic function-->Increased bone marrow hematopoietic function and increased cellular compensation

1. Cardiac output ⬇️, heart index ⬇️

2. Ejection fraction (EF) ⬇️

3. Ventricular end-diastolic pressure ⬆️

4. Increased heart rate: palpitations - often the earliest and most obvious symptom of patients with heart failure

Subtopic Changes in Arterial Blood Pressure

Redistribution of blood flow to organs

Seen in: Right heart failure and total heart failure

Performance

Seen in: Patients with left heart failure

Performance

rest

Reduce preload: diuretics, venodilators

Reduce afterload: hydralazine, CCB, ACEI

Sodium nitroprusside - reduces pre- and post-load

Metoprolol

growth hormone

Digitalis

calcium sensitizer

CCB

ventricular remodeling