老年慢性心力衰竭的多病因性及心衰类型分析

目的探讨老年慢性心力衰竭的多病因性及心衰类型,为临床老年慢性心衰的多元化及个性化治疗提供依据。方法对本科2008年2月～2009年2月收治的206例老年心衰患者,根据不同年龄段分成3组,对其多病因构成特点、心衰类型进行临床分析,并根据超声心动图对E／A、EF的测定结果进行心功能判断。结果老年心衰患者中,94．7％为多病因,基础疾病以冠心病、高血压、肺心病为主,合并疾病以COPD、糖尿病、心律失常为主,常见老年人心衰主要以舒张性心衰为主,占66．99％。结论老年心衰患者主要以冠心病、高血压、肺心病等为主要基础疾病,且主要以舒张性心衰为主,在治疗上应考虑到心衰的多病因性,进行多元化及个体化防治。     

高原老年重度心衰的治疗及护理特点

目的:探讨高原地区老年充血性心力衰竭的治疗及护理特点。方法:分析160例来自海拔2 261m~4 600m高原的老年充血性心力衰竭病人文献,总结了在高原地区进行治疗和护理的特点。结果:160例中有62例原发性高血压病,其中右心室肥厚者9例(14.51%);25例肺心病病人的红细胞压积(HCt)达44%~82%,合并冠心病者5例(20%,5/25)。老年重度心衰病人肺动脉压比率高、上呼吸道感染率高易诱发心衰,且症状多骤变,多并发症,有红细胞增多倾向。结论:在治疗护理高原老年急性心力衰竭中,应结合高原发病及病程特点,严防呼吸道反复感染,及时有效的氧疗,心电监护和药物治疗护理,监测并发病的发生是提高治疗效果和护理质量,及时挽救病人生命的有效举措。     

住院患者心力衰竭570例临床分析

目的进一步认识心力衰竭的病因和特点。方法对我科2005年1月～2009年5月住院心衰患者共570例进行分析。结果心力衰竭病因中冠心病排第一位,其次为高血压、心肌病等。结论冠心病、高血压、心肌病成为心力衰竭的主要病因,关注病因对心力衰竭的预防、治疗有指导意义。感染是最常见的发病诱因,必须积极预防。     

甲状腺素片佐治老年慢性心力衰竭病人疗效观察

目的:在常规抗心力衰竭治疗基础上,观察小剂量左甲状腺素钠片对老年人慢性心力衰竭的影响。方法:老年慢性充血性心力衰竭(CHF)伴甲状腺功能病态综合征(ESS)56例,随机分成对照组26例,常规抗心衰治疗;观察组30例,在常规抗心衰治疗基础上加用左甲状腺素钠片25~50μg,1次/天,4周后比较两组心衰症状、心功能指标、甲状腺激素水平的差异。结果:治疗4周后观察组与对照组心衰症状均有改善,血浆T3、左室射血分数(LVEF)治疗前后同组间比较明显升高;治疗后观察组血浆T3、LVEF明显升高。结论:老年慢性心力衰竭病人,补充小剂量甲状腺素,使血浆甲状腺素水平提高,有助于心功能的改善。     

巨噬细胞移动抑制因子和肿瘤细胞坏死因子-α在冠心病患者血浆中的变化

心力衰竭病因复杂，其中冠心病和高血压是引起心力衰竭的主要疾病，在发病机制方面，心衰的发生与神经内分泌以及细胞因子均有一定的关系。作为临床引起心衰的最常见原因，冠心病的发生和发展与机体各种细胞因子水平的关系的研究已引起基础医学和临床医学的广泛关注。     

肠道菌群在冠心病合并心衰患者中的变化及益生菌干预效果研究

目的 探讨肠道菌群在冠心病合并心力衰竭(心衰)患者中的变化及益生菌干预对炎性因子的影响.方法 ①选择2019年1-8月郑州大学第五附属医院体检科健康体检者15人为对照组,特需病房就诊的冠心病患者20例为冠心病组,冠心病合并心衰患者20例为合并组.采用PCR扩增及基因测序方法完成3组肠道菌群测定;将扩增后获得的PCR产物...     

老年人急性左心心力衰竭的特殊临床表现19例

大部分老年人的充血性心力衰竭以左心病变为基础，其急性衰竭(简称左心衰)的诊断较右心心力衰竭(简称右心衰)困难，若左心衰有某些特殊临床表现的诊治难度更大。为此，作者总结分析1998～2003年有特殊临床表现的老年左心衰19例(占同期左心衰病人的20．6％)，以期找出规律，为早期诊断提供依据。     

高原地区112例老年心力衰竭的临床特点及治疗

目的：分析高原地区老年心力衰竭的临床特点。方法：收集高原地区112例、平原地区32例老年心衰患者的临床资料，对其病因、临床症状、并发证、治疗方法及效果等进行回顾性分析。结果：高原地区老年心衰病因以高血压性心脏病和症状不典型者多见，肺部感染症状重，并发证以应激性溃疡出血、尿潴留、肾功能衰竭发生率高，转归较差。在常规利尿强心、活血化瘀基础上加用血管扩张剂疗效显著。结论：高原老年心衰临床症状重且不典型者多见。肺部感染以及尿潴留、肾衰等并发证常见且严重，尤其多脏器功能衰竭发生率高，伍用血管扩张剂疗效明显。     

老年慢性充血性心力衰竭的临床特点（附346例分析）

目的：探讨老年慢性充血性心力衰竭患者的临床特点。方法：回顾性对346例老年充血性心力衰竭患者进行临床分析,主要从老年充血性心力衰竭的病因、发病诱因及死亡等方面进行分析。结果：冠心病是老年充血性心力衰竭主要病因（55.2%）,其次是高血压性心脏病（21.1%）、风湿性心脏病（8.9%）及肺源性心脏病（8.2%）。感染是慢性充血性心力衰竭发病的主要诱因（68.2%）,其次是劳累（14.9%）、心律失常（10.8%）及精神情绪因素（5.7%）。结论：冠心病、高血压是发生老年充血性心力衰竭的主要病因,年龄越大,越易发生老年充血性心力衰竭。感染是老年充血性心力衰竭的主要诱因。     

慢性心力衰竭的诊断和治疗

心力衰竭(心衰)是由于各种器质性或功能性心脏疾病,损害了心室的充盈或射血能力而导致的一种复杂的综合征。早期诊断和治疗对改善病人生活质量,提高生存率具有重要意义。1病因、分类和临床评估(1)病因:大多数症状性心衰是因左心室心肌功能受损造成的,如冠心病的心肌缺血;糖尿病     

Acute hypercalcemia of the heart ("bony heart")

Cardiac abnormalities as a sign of hyperparathyroidism are common. A spectacular pitfall of peracute extended myocardiac hypercalcemia is reported. The history of a 30-year-old woman included symptoms such as insufficiency of the kidneys since childhood, secondary hyperparathyroidism, and hemodialysis for approximately 4 years. After kidney transplantation, the patient died from progressive heart failure. Three days before she died, CT showed a nearly white heart, and myocardial scintigraphy revealed a total infarction. The autopsy revealed a heart of normal size but with a weight of 590 g and with nearly bony texture. The histologic examination showed extended calcifications of the entire myocardium, thus explaining these findings. Laboratory photographs and electron microscopic images will be demonstrated. The metabolic pathogenesis of tertiary hyperparathyroidism and calciphylaxis is discussed. "Malignant" progression after kidney transplantation is stressed.     

Pathophysiological characteristics of heart rate recovery in heart failure

PURPOSE: Heart failure (HF) is associated with blunted HR recovery after exercise. The determinants of altered HR recovery in HF are unknown. The aim of this study was to investigate clinical correlates of HR recovery in HF patients. METHODS: Echocardiography, pulmonary function tests, exercise testing, and neurohormonal measurements were performed in 98 HF patients. HR recovery was calculated as the difference between heart rate at peak exercise and at 1 min into a recovery period. Study subjects were divided into three groups based on HR recovery tertiles: group 1 (HR recovery < or = 6 bpm), group 2 (7 < or = HR recovery < or = 12), and group 3 (HR recovery > or = 13). RESULTS: There were significant differences between the groups in multiple parameters. Compared with group 3, patients in group 1 had greater E/A ratios (1.81 +/- 0.26 vs 0.98 +/- 0.12, P = 0.011), shorter deceleration time (170 +/- 11 vs 223 +/- 11 ms, P = 0.016), and higher plasma atrial natriuretic peptide levels (207 +/- 32 vs 101 +/- 12 pg.mL, P = 0.008), indicating higher left ventricular filling pressures and elevated left atrial pressures. Pulmonary function tests were suggestive of greater restrictive changes in the lungs. Finally, subjects in group 1 had impaired exercise capacity, as evidenced by shorter exercise duration (5.2 +/- 0.2 vs 8.3 +/- 0.4 min, P < 0.001), lower peak VO2 (14.6 +/- 0.6 vs 22.2 +/- 1.0 mL.kg(-1).min(-1), P < 0.001), higher VE/VCO2 ratios (36.4 +/- 1.1 vs 31.1 +/- 0.9, P = 0.001), and reduced chronotropic responses to exercise (39 +/- 3 vs 69 +/- 4 bpm, P < 0.001). CONCLUSION: HR recovery may be a clinically useful index identifying HF patients with distinct echocardiographic, neurohormonal, and hemodynamic characteristics. This may have implications for our understanding of the pathophysiology of impaired HR recovery in HF as well as for the clinical evaluation of such patients.     

Porcelain heart

Rheumatic heart disease (RHD) was the leading-cause of death in individual aged 5-20 years a century ago. Developments in diagnosis and treatment, decreased the incidence of RHD and dropped its mortality-rate to less than 10% since the 1960s. Despite the existence of proven preventive strategies in early detection and management of rheumatic fever (RF), RHD remained the most common cause of cardiovascular-mortality and morbidity in patients with RF. Previous studies have showed that Jones criteria may have insufficient support to diagnose patients with RF. Patients with subclinical, ongoing, and unrecognized episodes of RF may present late to medical attention with complication of RF such as indolent carditis. Recent studies revealed the superior role of echocardiography, as compared with clinical screening to diagnose subclinical RHD. While valvular involvement and ventricular dysfunction of RHD can be easily detected with echocardiography and magnetic resonance imaging (MRI), it remains problematic to determine the presence of whether there is myocardial-calcification after rheumatic heart carditis and if yes, how much extent it involves. The current case-report suggests the superior role of computed tomography angiography (CTA), as compared with echocardiography and MRI, to diagnose RHD in individuals without known history of RF. CTA with high spatial-resolution accurately evaluates tissue characterization and simultaneous assessment of the anatomy and function of heart and coronaries, and can precisely differentiate RHD from other cause of porcelain heart. The use of CTA in RHD screening provides the opportunity to initiate secondary antibiotic prophylaxis to prevent the poor outcome of rheumatic heart disease.     

Function scintigraphy of the heart in patients with heart valve diseases

In 58 patients suffering from either stenosis or insufficiency of a single heart valve, gated blood pool scintigraphy was performed to determine the ejection fraction as well as the peak filling and peak ejection rates. It could be demonstrated that in patients with valvular disorders the ejection fraction was only moderately decreased, generally remaining in the lower reference range. The peak filling and ejection rates showed no pathologic changes with the exception of patients with aortic regurgitation where these rates were significantly decreased. Thus, the estimation of left ventricular peak filling and ejection rates may permit diagnosis of myocardial impairment in patients with valvular disease even under resting conditions.     

小切口不停跳心内直视手术的麻醉

目的：探讨小切口不停跳心内直视手术的麻醉处理。方法：回顾性分析235例小切口不停跳体外循环下心脏手术的麻醉。结果：全组早期死亡3例，死亡串1.28％。术中血流动力学稳定，42例患者心内畸形矫正后应用正性肌力药。96.17％(226/235)患者术后4h内拔除气管导管。术后无空气栓塞、神经系统并发症或麻醉死亡病例。结论：小剂量芬太尼、异氟醚复合麻醉是小切口不停跳心内直视手术的一种较好的麻醉方法，术中应注意彻底排气、加强呼吸道管理和循环功能支持。     

The pathology of the heart conduction system in congenital heart block

The incidence of congenital complete heart block is estimated in 1 of 2500-20,000 births. Many cases are isolated (found in an otherwise normal heart) and the pathology of the heart conduction system is variable. We report a 51-year-old man with the diagnosis of complete heart block, with a permanent pacemaker. No family history of rhythm disturbances was available. The patient presented and endocarditis after replacement of the pacemaker battery. The prognosis was poor and the patient died three months later. Autopsy examination showed signs of shock, of septic origin. The heart was hypertrophic (450g) and the left ventricle thickened. Histopathological examination of the heart conduction system showed that the sinus and atrioventricular nodes were normal, but the His bundle was interrupted and replaced by fibrous tissue. No inflammatory signs were present. Loss of conducting fibres and their replacement by fibrous tissue is the most common pathological process in complete heart block. In this case His bundle was mostly affected, different to Lev's disease where the process is more distal (branching atrioventricular bundle) and to Lenegre's disease, which shows a diffuse damage in the conducting system.     

Electron-beam-computed-tomography of the heart

Summary Using electron-beam computed tomography (EBCT) with short exposure times of 100 or 50 ms and the capability of acquiring up to 2 × 17 images/s it is possible to study most of the important morphological and functional determinants of the heart. Various examples of studies in acute and chronic cardiac diseases are shown to demonstrate the use of EBCT to determine quantitatively left ventricular volumes (ml), myocardial mass (g), wall thickness changes over the cardiac cycle (mm/s), myocardial perfusion (ml/100 g/min) and the extent of coronary calcification (calcium score) and qualitatively the state of the proximal 4–6 cm of the subepicardial coronary arteries. The knowledge of these determinants seems very useful in excluding cardiac dysfunction, in the early recognition of cardiac disease and in the evaluation of the haemodynamic severity of coronary artery stenotic lesions. Further interdisciplinary studies are necessary to assess the clinical validity of these cardiac determinants, especially myocardial perfusion, using this advanced CT technology. Eingegangen am 27. Januar 1997 Angenommen am 27. Januar 1997