心力衰竭概述及常见治疗方案_心力衰竭

在正常心脏中，脱氧血液从身体流经上腔静脉和下腔静脉进入右心房。
然后，被称为前负荷的血液进入右心室，右心室收缩，将血液送出心脏，进入肺部，清除二氧化碳并收集氧气。
含氧血液从肺部进入左心房，然后进入左心室，左心室收缩，将含氧血液送出心脏，进入全身循环，抵御称为后负荷的阻力。
当心脏无法泵出足够的血液来满足自身或身体的需要时，就会被诊断为心力衰竭。
左侧心力衰竭时，左心室不能泵出足够量的含氧血液进入体循环
左侧心力衰竭会导致肺充血，肺组织中的血液和液体积聚，从而影响呼吸。
为了应对低氧水平，心率会加快，以补偿左心室的衰弱状态并满足身体对氧的需求，久而久之会导致心肌增厚或肥大，因为心肌要努力将血液推出心脏，对抗肺血管中不断增加的压力和肺中的液体，并继续心肌损伤的循环。
右侧心力衰竭时，右心室无法以足够的力量收缩，使足够的血液通过肺动脉到达肺部供氧
右侧心力衰竭会导致血液在静脉循环中积聚，引起全身水肿
由于缺乏足够的血流量，肾脏无法过滤血液中过多的钠和水，从而导致体液失衡和血管阻力增加，心脏必须对其进行泵血。
其结果是心脏过度劳累的组织长期受损
心力衰竭的治疗包括改变饮食和运动等生活方式、药物治疗、手术治疗或多种方法的综合治疗
右侧心力衰竭的治疗通常以改善左侧心脏功能为目标
心力衰竭时，体液量的增加会给负荷过重的心脏增加压力
利尿药通过抑制肾脏肾小管系统对钠和水的重吸收，增加尿液中钠和水的排泄量以及尿量，从而减少液体容量和静脉回流。
ACE 抑制剂可阻断肾素-血管紧张素-醛固酮系统中的激素，从而扩张血管，降低血容量和静脉回流，减轻心脏的工作负荷，阻止心室肥大。
地高辛是一种通过提高细胞内钠和钙浓度来增加心肌收缩力的药物。
为了补偿心衰时心输出量的减少，交感神经系统会释放去甲肾上腺素，从而提高过度劳累的心脏的心率和收缩力。
β-受体阻滞剂可与去甲肾上腺素分子竞争心肌细胞上的结合位点，阻止去甲肾上腺素的作用，从而降低收缩的速度和强度，支持更有效的体内循环。

In the normal heart

在正常心脏中,

deoxygenated blood flows from the body through the superior and inferior vena cava into the right atrium

脱氧血液从身体流经上腔静脉和下腔静脉进入右心房·

The blood a volume known as preload then moves into the right ventricle

然后,被称为前负荷的血液进入右心室,右心室收缩,

which contracts and sends blood out of the heart and into the lungs to remove carbon dioxide and collect oxygen

将血液送出心脏,进入肺部,清除二氧化碳并收集氧气·

Oxygenated blood moves from the lungs into the left atrium

含氧血液从肺部进入左心房,

then moves into the left ventricle which contracts and propels oxygenated blood out of the heart

然后进入左心室,左心室收缩,将含氧血液送出心脏,

and into the systemic circulation against resistance known as after load

进入全身循环,抵御称为后负荷的阻力·

When the heart losses its ability to pump enough blood to meet its needs or those of the body

当心脏无法泵出足够的血液来满足自身或身体的需要时,

the diagnosis is heart failure

就会被诊断为心力衰竭·

In left sided heart failure

左侧心力衰竭时,

the left ventricle does not pump an adequate volume of oxygenated blood into the systemic circulation

左心室不能泵出足够量的含氧血液进入体循环

Left sided heart failure causes pulmonary congestion

左侧心力衰竭会导致肺充血,

a buildup of blood and fluid in the lung tissues that interferes with respiration

肺组织中的血液和液体积聚,从而影响呼吸·

In response to the low levels of oxygen

为了应对低氧水平,

the heart rate increases to compensate for the left ventricle's weakened state and to meet the body's oxygen demands

心率会加快,以补偿左心室的衰弱状态并满足身体对氧的需求,

which in time leads to thickening or hypertrophy of the myocardium

久而久之会导致心肌增厚或肥大,

as it labors to push blood out of the heart

因为心肌要努力将血液推出心脏,

against the increasing pressure in the pulmonary vessels and fluid in the lungs

对抗肺血管中不断增加的压力和肺中的液体,

and continuing the cycle of cardiac muscle damage

并继续心肌损伤的循环·

In right sided heart failure

右侧心力衰竭时,

the right ventricle is unable to contract with enough force

右心室无法以足够的力量收缩,

to drive enough blood through the pulmonary arteries to the lungs for oxygenation

使足够的血液通过肺动脉到达肺部供氧

Right sided heart failure results in a buildup of blood in the venous circulation

右侧心力衰竭会导致血液在静脉循环中积聚,

causing fluid retention called edema throughout the body

引起全身水肿

Deprived of sufficient blood flow

由于缺乏足够的血流量,

the kidneys fail to filter excessive sodium and water from the blood

肾脏无法过滤血液中过多的钠和水,

leading to a fluid imbalance and increased vascular resistance against which the heart must pump

从而导致体液失衡和血管阻力增加,心脏必须对其进行泵血·

The result is perpetual damage to the heart's overworked tissues

其结果是心脏过度劳累的组织长期受损

Treatment for heart failure involves changes in lifestyle

心力衰竭的治疗包括改变生活方式

such as diet and exercise medication surgery or a combination of approaches

例如饮食和运动、药物治疗、手术治疗或多种方法的综合治疗

Commonly therapies for right sided heart failure are geared toward improving left sided cardiac function

右侧心力衰竭的治疗通常以改善左侧心脏功能为目标

In heart failure an increase in fluid volume places added stress on the overloaded heart

心力衰竭时,体液量的增加会给负荷过重的心脏增加压力

Diuretic medications reduce fluid volume and venous return by inhibiting sodium and water reabsorption along the kidney's renal tubular system

利尿药通过抑制肾脏肾小管系统对钠和水的重吸收,

increasing the amounts of sodium and water excreted in the urine and the volume of urine produced

增加尿液中钠和水的排泄量以及尿量,从而减少液体容量和静脉回流·

ACE inhibitors block hormones in the renin angiotensin aldosterone system

ACE 抑制剂可阻断肾素-血管紧张素-醛固酮系统中的激素,

dilating vessels

从而扩张血管,

lowering blood volume and venous return

降低血容量和静脉回流,

decreasing the heart's workload

减轻心脏的工作负荷,

and halting ventricular hypertrophy

阻止心室肥大·

Digoxin is a medication that increases the force of myocardial contractility by raising intracellular sodium and calcium concentrations

地高辛是一种通过提高细胞内钠和钙浓度来增加心肌收缩力的药物·

To compensate for the decreased cardiac output in heart failure

为了补偿心衰时心输出量的减少,

the sympathetic nervous system initiates norepinephrine release

交感神经系统会释放去甲肾上腺素,从而提高过度劳累的心脏的心率和收缩力·

raising the overworked heart's rate and force of contractions

从而提高过度劳累的心脏的心率和收缩力·

Beta blockers are prescribed to compete with norepinephrine molecules for binding sites on cardiomyocytes

β-受体阻滞剂可与去甲肾上腺素分子竞争心肌细胞上的结合位点,

preventing norepinephrine's effects

阻止去甲肾上腺素的作用,

resulting in reduced speed and strength of the contractions

从而降低收缩的速度和强度,

which can support more efficient circulation through the body

支持更有效的体内循环·