Current concept in the diagnosis,treatment and rehabilitation of patients with congestive heart failure

Heart failure(HF)is a major public health problem with a prevalence of 1%-2%in developed countries.The underlying pathophysiology of HF is complex and as a clinical syndrome is characterized by various symptoms and signs.HF is classified according to left ventricular ejection fraction(LVEF)and falls into three groups:LVEF≥50%-HF with preserved ejection fraction(HFpEF),LVEF<40%-HF with reduced ejection fraction(HFrEF),LVEF 40%-49%-HF with mid-range ejection fraction.Diagnosing HF is primarily a clinical approach and it is based on anamnesis,physical examination,echocardiogram,radiological findings of the heart and lungs and laboratory tests,including a specific markers of HF-brain natriuretic peptide or N-terminal pro-B-type natriuretic peptide as well as other diagnostic tests in order to elucidate possible etiologies.Updated diagnostic algorithms for HFpEF have been recommended(H2FPEF,HFA-PEFF).New therapeutic options improve clinical outcomes as well as functional status in patients with HFrEF(e.g.,sodium-glucose cotransporter-2-SGLT2 inhibitors)and such progress in treatment of HFrEF patients resulted in new working definition of the term“HF with recovered left ventricular ejection fraction”.In line with rapid development of HF treatment,cardiac rehabilitation becomes an increasingly important part of overall approach to patients with chronic HF for it has been proven that exercise training can relieve symptoms,improve exercise capacity and quality of life as well as reduce disability and hospitalization rates.We gave an overview of latest insights in HF diagnosis and treatment with special emphasize on the important role of cardiac rehabilitation in such patients.

Diagnosis and surgical treatment of intraveneous leiomyomatosis extending into the heart:two cases report and review of the literature

Objective： To investigate the clinical characteristics, diagnosis and surgical treatment of intravenous leiomyomatosis （IVL）, and outline the differences between Chinese and overseas cases. Methods： Clinical data of two IVL cases, treated in our hospital, were analyzed retrospectively and the related literature was also reviewed. The data of preoperative diagnostic rate, surgical procedures, and postoperative recurrence between patients in China and other countries were compared. Results： The first stage operation was performed successfully in 2 patients. However, they refused subsequent therapies, including a second stage operation to excise the remnants Of the tumor, uterus, bilateral oviducts and ovaries, and anti-estrogen therapy. Both suffered from IVL recurrence, one at 6-month and the other at 9-month, and died at 16-month and 12-month respectively after the first stage surgery. Worldwide reports of 110 IVL cases were reviewed, which included 28 cases in China and 82 cases in other countries. In the majority of the Chinese patients, tumors only extended into the fight atrium rather than the right ventricle （RA 22 cases vs RV 4 cases）. However, among the overseas patients, the rate of extension into the right atrium was similar to that of extension into the right ventricle （RA 41 cases vs RV 38 cases）. The rate of hysterectomies was not significantly different between Chinese and overseas patients （ 67.86% vs 55.9%, P=0.278）. The rate of correct preoperative diagnosis in the Chinese patients was significantly lower than that in the overseas patients （32.14% vs 80%, P=0.000002.）, as well asthe rate of complete excision of the tumor （22.7@0 vs 75.5%, P=0.000001）. The proportion of patients who undergoing a single-stage or a two-stage operation was similar in Chinese and overseas patients. The recurrence rate was significantly higher in the Chinese patients than in the overseas patients （36.8% vs 9.1%, P=0.0055）, and the patients with tumor recurrence were partial tumor excision patients. Conclusion： The possibility of IVL should be considered if echocardiography in female patients demonstrates a tumor in the right heart and a mass in the inferior vena cava （IVC）. Further imaging should be performed to confirm the diagnosis. The correct diagnosis and accurate preoperative delineation of tumor extension are essential for an optimal surgical outcome. The key point in IVL treatment is the complete excision of tumors （single-stage or two-stage surgical procedure）.

The role of B-type natriuretic peptide in the diagnosis and treatment of decompensated heart failure

Heart failure (HF) is a common disease associated with increasing age. B-type natriuretic peptide (BNP), is a cardiac neurohormone, and is released as prepro BNP and then enzyrnatically cleaved to the Ntenninal-proBNP (NT-proBNP) and BNP upon ventricular myocyte stretch. Blood measurements of BNP have been used to identify patients with I-IF. The BNP assay is currently used as a diagnostic and prognostic aid in HF. In general, a BNP level below 100 pg/mL excludes acutely decompensated HF and levels ＞ 500 pg/ml indicate decompensation. Recombinant human BNP (hBNP, nesiritide) is an approved intravenous treatment for acute,decompensated -HF. Nesiritide given in supraphysiologic doses causes vasodilation, natriuresis, diuresis, and improved symptoms over the course of a 48-hour infusion. This paper will sort out the literature concerning the use of this peptide both as a diagnostic test and as an intravenous therapy.

Review of Medical Treatment of Stable Ischemic Heart Disease

Medical treatment is the initial treatment strategy and is the cornerstone of management in patients with stable ischemic heart disease (IHD). Many patients are not suitable for percutaneous or surgical revascularization because of unfavourable anatomy, or the presence of co-morbidities. In addition, many patients have recurrence of angina following revascularization due to restenosis or incomplete revascularization. Furthermore, randomized clinical trials comparing optimal medical treatment to revascularization have not clearly shown that myocardial revascularization is superior to optimal medical treatment. Traditional drugs for angina treatment include b-blockers, calcium channel blockers and nitrates. Newer drugs are available with different mechanisms of action and with equal efficacy that do not cause significant hemodynamic deterioration. The availability of these newer drugs expands the therapeutic potential of medical treatment to even a wider population with stable IHD. Revascularization in patients with stable ischemic heart disease has never been shown to reduce hard endpoints (death or myocardial infarction) in randomized clinical trials.

基于“心-脉-神”互言探讨肝心同治冠心病合并抑郁(双心疾病)的理论研究

双心疾病作为“血脉之心”与“神明之心”同病的复合疾病,已经成为现代社会影响人类健康的主流问题之一,其中的冠心病合并抑郁属于临床中常见的发病类型。冠心病是一种严重威胁健康的心血管疾病,焦虑和抑郁是其不良预后的潜在危险因素。冠心病合并抑郁属中医“胸痹”“郁证”范畴,“心藏脉,脉舍神”,心脏对生命活动具有重要的控制和调节作用,“从心论治”使机体心主神明、心主血脉功能正常发挥。心血管疾病与情志病是密不可分的,胸痹患者心脉不畅,肝失疏泄,痰瘀互结,气机郁滞加重,由此引发情志的改变。双心疾病与中医的“心主血脉”“心主神明”“肝主藏血”“肝主疏泄”功能失常密切相关,“心”与“肝”的状态失衡是导致疾病进展的主要因素,故“肝心同治”是调节关键病机-肝心失调的必由之法,以疏肝解郁、调气和血为主。基于对“从心论治”“心-脉-神”与“肝心同治”的理论探讨,结合现代科学技术,旨在为防治冠心病合并抑郁提供新的思路与机制预测。

浅议“五脏六腑皆令人不寐,非独心也”

不寐是临床上常见的一种睡眠障碍,长期不寐对人们的工作、生活和学习造成很大的影响,给患者、家庭和社会带来不同程度的隐患和危害。作者查阅古代医家文献及现代诸多学者论文基础上,结合多年临床治疗不寐经验,提出“五脏六腑皆令人不寐,非独心也”观点。文章分别从生理状态、病理变化、中医药治疗等方面就不寐与五脏六腑的管理进行论述,认为生理情况下人体各脏腑各司其职,互相协调,方可正常寤寐。病理情况下,各种因素引起五脏六腑功能失常,直接或间接导致心神不宁、心神失养,阴阳失交,从而产生不寐。因不寐的发病与五脏六腑均有密切联系,故概括为“五脏六腑皆令人不寐,非独心也”。通过探讨不寐与脏腑的关系,旨在拓宽临床不寐中医论治思路,为不寐的中医辨证论治开辟新思路和方案。

Epidemiology and Management of Heart Failure in the Medicine Department of Tombouctou Hospital

Introduction: Heart failure is a complex syndrome and very frequently observed and secondary to the outcome of many advanced heart diseases. It is made up of a set of symptoms that reflect the tissue and visceral consequences of heart failure. The objective was to determine the hospital prevalence and to describe the management of heart failure in the medical department of Tombouctou hospital in Mali. Methods: This is a descriptive cross-sectional study with retrospective data collection, carried out over 24 months and involving the analysis of 266 records of patients hospitalized for heart failure. Results: The frequency of heart failure was 17.6% with a female predominance. The average age was 48 years with extremes of 16 and 90 years. Cardiovascular risk factors were dominated by high blood pressure with 38%. Global heart failure was the mode of discovery in 72.2% of cases. The etiologies were dominated by hypertensive dilated cardiomyopathy in 36.8% and peripartum cardiomyopathy in 32% of cases. The majority of our patients benefited from diuretic treatment, i.e. 95.9% frequency;with a favorable evolution in 96.2% of cases. We recorded 10 deaths, i.e. a lethality of 3.7%. We report some difficulties encountered during our security study because Tombouctou is a war zone and the lack of a technical platform for biology such as (BNP or NT-proBNP). Conclusion: Heart failure is a real public health problem. Its prevalence is increasing due to the aging of the population and especially the poor management of arterial hypertension in our context.

《中国心力衰竭诊断和治疗指南2024》要点解读

近年来,心力衰竭(下文简称“心衰”)的治疗特别是药物治疗取得了突破性进展,慢性心衰的分类、心衰及其合并症的治疗方案等也在不断更新。为进一步提升我国心衰的诊疗水平,中华医学会心血管病学分会、中国医师协会心血管内科医师分会、中国医师协会心力衰竭专业委员会、中华心血管病杂志编辑委员会联合制定了《中国心力衰竭诊断和治疗指南2024》,该指南在心衰分类与分期、评估与诊断、治疗以及中国证据等方面进行了重要更新和优化,为心衰诊断和治疗提供了更为全面、精细的指导。本文将对指南的主要推荐内容进行解读,以便读者能够更好地理解和掌握其核心内容。

心肺运动试验在心力衰竭患者中的应用现状及展望

近年来,心力衰竭(简称心衰)已成为巨大的公共卫生负担。心肺运动试验(cardiopulmonary exercise test,CPET)可为心衰患者提供详尽的生理学指标变化,并评估治疗效果,从而改善患者预后。本文总结了心衰患者CPET常用指标并评价其安全性,分析了CPET在心衰患者诊断、治疗、预后中的应用现状,为未来CPET在心衰患者中的应用提供新思路。

中国儿童肺动脉高压诊治现状

肺动脉高压是一类具有不同的病因和发病特点、多因素致病的疾病。中国儿童肺动脉高压最常见的类型是先天性心脏病相关肺动脉高压和特发性肺动脉高压。现重点介绍这两类疾病的诊治现状,同时介绍与儿童肺动脉高压相关的其他疾病,以及分析当前存在的问题和挑战,并对未来进行展望。

Diagnosis and treatment of heart failure with preserved left ventricular ejection fraction

Nearly six million people in United States have heart failure.Fifty percent of these people have normal left ventricular(LV)systolic heart function but abnormal diastolic function due to increased LV myocardial stiffness.Most commonly,these patients are elderly women with hypertension,ischemic heart disease,atrial fibrillation,obesity,diabetes mellitus,renal disease,or obstructive lung disease.The annual mortality rate of these patients is 8%-12%per year.The diagnosis is based on the history,physical examination,laboratory data,echocardiography,and,when necessary,by cardiac catheterization.Patients with obesity,hypertension,atrial fibrillation,and volume overload require weight reduction,an exercise program,aggressive control of blood pressure and heart rate,and diuretics.Miniature devices inserted into patients for pulmonary artery pressure monitoring provide early warning of increased pulmonary pressure and congestion.If significant coronary heart disease is present,coronary revascularization should be considered.

左西孟旦在急性心肌梗死合并心力衰竭患者中的应用

目的 分析左西孟旦在急性心肌梗死(AMI)合并心力衰竭患者中的应用效果。方法 选取2018年1月至2022年11月北京市大兴区人民医院收治的106例AMI合并心力衰竭患者作为研究对象,按照随机数字表法将其分为两组,各53例。对照组采用标准化治疗,观察组同时联合左西孟旦治疗。比较两组治疗前后血清炎症因子[超敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)]、血流动力学水平[心指数(CI)、全心舒张末容积指数(GEDVI)、全身血管阻力指数(SVRI)]、心功能指标[左室射血分数(LVEF)、每搏输出量(SV)、B型尿钠肽(BNP)],及临床疗效和不良反应总发生率。结果 治疗后,两组hs-CRP、IL-6、TNF-α、GEDI、SVRI、BNP水平均低于治疗前,且观察组低于对照组(P<0.05);治疗后,两组CI、LVEF、SV水平均高于治疗前,且观察组高于对照组(P<0.05)。观察组临床疗效高于对照组(P<0.05)。两组不良反应总发生率比较,差异无统计学意义(P>0.05)。结论 标准化治疗基础上联合左西孟旦治疗AMI合并心力衰竭能够有效缓解患者的炎症反应,稳定血流动力学,改善心功能和临床疗效,且无明显不良反应。

Treatment of patients with bosentan in postoperation of congenital heart disease with pulmonary arterial hypertension:a double-blind,randomized controlled trial

Objective Endothelin is a key role in the pathogenic of pulmonary arterial hypertension. High concentrations of endothelin 1 have been recorded in plasma and lungs of patients with pulmonary artery hypertension associated with congenital heart disease,and the concentrations of endothelin-1 was correlated with severity degree

诸“神”穴的命名及临床证治特点浅析

腧穴命名皆有深意,在腧穴的名称里,含有“神”字的腧穴共有9个,本文从诸“神”穴的命名规律、穴名释义、分布规律、临床证治等方面进行归纳总结分析,发现诸“神”穴的分布与心、脑密切相关,具有“中轴对称”和“群体组合布局”两大显著特点,该类腧穴除了具有一般腧穴的主治特点外,其临床证治及配伍主治与心脑血管病及人的精神神志类疾病密切相关,临床上治疗这类疾病时常选取各“神”穴相配或者配合他穴协同使用以发挥作用,诸“神”穴的临床运用也直接或间接体现了“心主神明”“脑为元神之府”的中医经典理论。

失眠认知行为治疗结合中医治疗对老年冠心病合并睡眠障碍患者的临床疗效分析

目的观察失眠认知行为治疗(CBT-I)结合中医治疗在老年冠心病合并睡眠障碍患者中的应用效果。方法选择2021年6月至2023年9月在新疆医科大学第一附属医院收治的400例老年冠心病合并睡眠障碍患者,随机分成研究组和对照组各200例,对照组采取常规治疗,研究组以CBT-I疗法结合中医治疗进行治疗。以匹兹堡睡眠质量指数量表(PSQI)、生活质量量表(SF-36)、抑郁自评量表(SDS)、焦虑自评量表(SAS)以及西雅图心绞痛量表(SAQ)评价两组患者的治疗效果。结果治疗后,两组患者的入睡时间、睡眠时间、睡眠效率、睡眠质量、催眠药物、日间功能、睡眠障碍评分均较治疗前降低,且研究组低于对照组(P<0.05);两组患者在生理机能、生理职能、躯体疼痛、一般健康状况、精力、社会功能、情感职能、精神健康、健康变化评分均较治疗前升高,且研究组高于对照组(P<0.05);两组患者SAS、SDS评分均较治疗前降低,且研究组低于对照组(P<0.05);两组患者的身体活动受限程度、心绞痛稳定状态、心绞痛发作情况、治疗满意程度、疾病认知程度评分均较治疗前上升(P<0.05),且研究组高于对照组(P<0.05)。结论失眠认知行为治疗结合中医治疗可有效提高老年冠心病睡眠障碍患者睡眠质量,改善生活质量,促进冠心病功能状态稳定并降低其焦虑抑郁程度。

张艳自拟冠心方治疗冠心病心绞痛临证经验

冠心病心绞痛在心血管疾病中较为常见,属于中医学中“胸痹”“心痛”等范畴。张艳教授行医四十余载,治疗胸痹心痛疗效显著。认为其发病以气虚痰瘀交阻证型较为多见,提出“虚痰瘀”理论,自拟“冠心方”从脾论治冠心病心绞痛,治法为补气健脾,养血活血,化瘀止痛,化痰祛湿。该文章将张艳教授自拟冠心方治疗冠心病心绞痛的临证经验总结作出详细介绍。

《中国心力衰竭诊断与治疗2024》临床实践更新

心力衰竭患者预后较差,再住院率高、病死率高。近年来,心力衰竭的诊断、治疗、预防和管理均取得了重大进展,2024年3月《中国心力衰竭诊断与治疗指南2024》重磅发布,新版指南更新了心力衰竭分类与分期,对不同类型射血分数心力衰竭患者分类而治等,在心力衰竭临床实践过程中具有重要价值。本文就心力衰竭的定义、分类与分期,慢性、急性心力衰竭的规范化诊治作一述评。

心脏瓣膜相关生物力学模型建立的研究进展

心脏瓣膜生物力学是一个迅速发展的、与临床高度相关的研究领域。已知大多数瓣膜疾病都源于生物力学改变,无创成像方式的出现,使评估和研究这些病变原理和治疗方法的技术取得了重大进展。计算机建模、体内外建模技术推动了研究人员更好地理解心脏瓣膜的生物力学、病理学和介入治疗学。其中,体外建模技术更是一种可供临床转化研究的前景巨大的技术,它在计算机建模和体内建模的基础上更加深入的研究瓣膜生物力学。

基于五脏相关理论分期辨治慢性心衰

慢性心衰是各种心脏疾病发展至终末阶段的复杂综合征,其发生发展是各脏腑共同作用的结果。国医大师任继学教授、邓铁涛教授均倡导从五脏相关出发辨治慢性心衰,刘爱东教授总结多年临证经验,深入体会五脏相关理论与慢性心衰的科学内涵,探讨在该理论指导下分期辨治慢性心衰。根据病程不同阶段,主要分为三期,Ⅰ期多以心气不足,肺气壅塞为主,Ⅱ期多见脾虚肺闭,心肝血瘀,而病至Ⅲ期多为五脏衰弱,虚实夹杂,并附医案一则详细阐释临证思路,以飨同道。

卒中及共患疾病诊疗模式探索与实践

近年来,虽然国内外学者对卒中及共患疾病的关注逐步提高,但由于多病共存的特殊性和异质性,针对此类患者的诊治仍存在诸多不足和挑战。卒中及共患疾病的诊疗能力很大程度上反映了医疗机构的神经系统专科技术水平和多学科协同救治能力。构建多学科协同诊疗模式是卒中救治和质量管理体系建设的重要内容之一。医疗机构应运用先进的质量管理工具,优化要素配置和运行机制,建立高效的多学科协同诊疗模式,从而实现卒中及共患疾病整体诊治水平的提升。