2015年 · 第43卷第12期

The current medical service model in China is passively waiting for people to get sick, waiting for those who are not sick to get sick, waiting for those who get sick to relapse, sitting in the hall to practice medicine, being a sitting doctor, preventing and treating disconnect, and fragmenting medical services. If you don't prevent it before, regardless of it after (such as rehabilitation), if you suffer from emergencies (such as acute myocardial infarction), you will be treated late, and the hospital will become a human body overhaul shop. At the same time, almost all limited medical and health resources are used for biomedical technology, such as tablets, stents, pacemakers, defibrillators, scalpels, robots, artificial hearts, heart transplantation, etc., while for prevention, rehabilitation and essential lifestyle intervention, less attention is paid, the medical insurance payment mechanism is lacking, and the core content of medical care-services cannot reflect the value.

Heart failure (HF) is the severe and terminal stage of many kinds of cardiovascular diseases, and it is an important content of the prevention and treatment of chronic cardiovascular diseases worldwide. European and American epidemiological data show that the prevalence of heart failure in adults is 1% ~2%, and increases with age, and even more than 10% of the elderly over 70 years old^[1,2]。 Data from the United States show a growing trend in the prevalence of heart failure, with a 34 percent increase in the decade between 1994 and 2003^[3,4]。 The 2003 China Epidemiological Survey found that the prevalence of heart failure in Chinese adults was 0.9%^[5]The "China Cardiovascular Disease Report 2013" proposed that the prevalence of cardiovascular diseases in my country is in a continuous rising stage^[6]From the characteristics of "event chain and stage" development of heart failure, the increasing prevalence of cardiovascular diseases and their risk factors will lead to an increase in the prevalence of heart failure at the end point of the event chain, especially the aging trend of China's population will also make the future development of heart failure even larger. It is our focus now and in the future to grasp the epidemiological characteristics of heart failure in China and carry out effective prevention and control.

The prevalence and mortality of heart failure (HF) are increasing year by year in both developed and developing countries. The diagnosis and clinical evaluation of heart failure are mainly based on the clinical symptoms, signs and auxiliary examinations of patients, among which the status of biomarkers has gradually received attention. At present, it is believed that B-type natriuretic peptide (BNP) and N-terminal B-type pronatriuretic peptide (NT-proBNP) in the natriuretic peptide family are the "gold standard" among biomarkers of heart failure, and they have certain value in the diagnosis, prognosis evaluation, disease monitoring and treatment guidance of heart failure.

Heart failure (HF) is a complex group of clinical syndromes in which ventricular filling or ejection capacity is impaired due to abnormalities in the structure or function of the heart. There are more than 23 million patients with heart failure worldwide. Among adults aged 35 to 74 in China, more than 4 million patients have heart failure^[1,2]。 According to statistics, deaths due to heart failure in the United States have increased sixfold in the past 40 years, and the incidence continues to increase^[3]It can be seen that heart failure has become an important public health problem in the 21st century.

A 64-year-old male was admitted to the hospital on 5 November 2014 due to "sudden chest pain for 3 h". Previous history of hypertension for 5 years, blood pressure up to 150/90 mmHg (1 mmHg =0.133 kPa), denied history of diabetes, no tobacco or alcohol addiction. Admission physical examination: body temperature 36.2 ℃, pulse 44 beats/min, breathing 16 beats/min, blood pressure 73/48 mmHg; Sleepiness, apathy; The pupils on both sides are equal in size and round; No jugular dilatation; The breathing sounds of both lungs were thick, and a few scattered wet rales were smelled; The heart rate was 44 beats/min, the rhythm was uniform, the heart sound was low and dull, and no pathological murmur was heard in the auscultation area of each valve; Soft abdomen, no tenderness; There was no edema in both lower limbs. Emergency room electrocardiogram showed: sinus heart rate, heart rate 81 beats/min; Complete right bundle branch block; ST segment elevation in leads Ⅱ, Ⅲ and aVF was 0.2 mV, V₁~ V₃Lead T-wave high tip, V₄~ V₆Lead ST segment elevation 0.1~0.2 mV (Figure 1)。 Electrocardiogram after admission showed: sinus rhythm, heart rate 43 beats/min; Complete right bundle branch block, third degree atrioventricular block; The ST segment of Ⅱ, Ⅲ and aVF leads was still elevated, and V₁~ V₄Lead ST segment depression. The admission diagnosis was acute inferior myocardial infarction, third-degree atrioventricular block, cardiogenic shock, cardiac function grade IV (Killip grade), and hypertension grade 1 (very high risk group).

A 69-year-old male was admitted to our hospital for treatment on December 12, 2014 due to intermittent dizziness, amaurosis and syncope for 3 days. Three days before admission, the patient had repeated dizziness and amaurosis without obvious triggers, accompanied by transient loss of consciousness. He woke up 1 to 3 minutes after each attack, without limb twitching, foaming at the mouth and limb bites, incontinence, and disorder of limb movement after the attack. He sought treatment in our outpatient clinic. Electrocardiogram examination showed: third-degree atrioventricular block, ventricular rate 36 beats/min; Then he was hospitalized for "arrhythmia". After asking about the past medical history, the patient has chronic obstructive pulmonary disease for more than 20 years and has been treated in the respiratory department of our hospital many times; Have a history of hypertension for more than 10 years; History of diabetes for more than 1 year; Severe aortic valve stenosis and severe regurgitation were found for more than 1 year. He was repeatedly hospitalized in our department for "valvular heart disease and cardiac insufficiency", but the recurrent attacks occurred after the correction of cardiac insufficiency. On October 8, 2014, he was punctured in the femoral artery under local anesthesia in Fuwai Cardiovascular Hospital of Chinese Academy of Medical Sciences and underwent transcatheter aortic valve implantation (Valve-in-Valve implantation, TAVI). The name and model of the aortic valve was Venus-A 29 mm (new self-expanding aortic valve). Color ultrasound before TAVI showed: valvular heart disease, moderate aortic stenosis and massive regurgitation. Preoperative plain scan of heart and coronary arteries + enhanced multi-slice CT showed that the aortic valve was three valves, the leaflets were thickened and calcified, the coronary lumen was well developed, no meaningful stenosis was found, and the aortic atherosclerotic changes were found; In the scanned area, both lungs were scattered with bullae. Pulmonary function tests showed severe obstructive ventilatory dysfunction. Cardiac color ultrasound after TAVI showed that after percutaneous interventional aortic valve implantation, there was no abnormal function of the prosthetic valve, and a small amount of regurgitation around the prosthetic valve; Postoperative heart and coronary artery plain scan + enhanced multi-slice CT showed: good stent adhesion, no paravalvular leakage, good coronary lumen imaging, no meaningful stenosis, and aortic atherosclerotic changes; In the scanned area, both lungs were scattered with bullae. Electrocardiograms before and after TAVI showed sinus tachycardia without any type of conduction block; After admission to our hospital, the electrocardiogram showed (December 12, 2014): third-degree atrioventricular block. After admission, there were no obvious abnormalities in serum ion, renal function and blood gas analysis repeatedly. Continuous ECG monitoring revealed third-degree atrioventricular block. On December 13, 2014, a permanent pacemaker was placed in our hospital, and a double-chamber pacemaker (St. Jude Company, USA) was installed. Postoperative electrocardiogram showed that the pacemaker had good pacing and sensory function, and no symptoms of dizziness and amaurosis were repeated. The patient was discharged on 21-Dec-2014 after removal of sutures at the incision of the pacemaker surgery.

Chronic heart failure (HF) is a severe stage of various heart diseases. Even with optimized comprehensive treatment, the prognosis of patients is still very poor, and the 5-year survival rate is comparable to that of malignant tumors^[1]。 In recent years, studies have found that malnutrition is an independent predictor of adverse clinical outcomes in patients with heart failure, and it is a key link in the occurrence and development of cachexia. Once it enters the stage of cachexia, the disease process is irreversible and the intervention effect is poor. Therefore, early determination of the nutritional status of patients with heart failure and nutritional intervention may become an important research direction to improve the prognosis^[2]。 However, so far, the available information on nutritional management of heart failure is very limited, and in particular, authoritative recommendations on nutritional evaluation are almost blank. This article reviews the nutritional evaluation and prognostic prediction of patients with heart failure.

immunoglobulin (Ig) G4-related disease is a kind of systemic disease that has only been recognized and received widespread attention in recent years. It is characterized by swelling of the lesion site, infiltration of a large number of lymphoid plasma cells in the affected tissue, especially IgG4-positive plasma cells, and matted fibrosis. It is often accompanied by increased serum IgG4, but it can also be normal. Current studies have found that IgG4-related diseases can affect various organs, such as the pancreas (spontaneous pancreatitis)^[1]Lacrimal gland (Mikulitz's disease)^[2]Retroperitoneal (retroperitoneal fibrosis)^[3]aorta (aortic aneurysm, aortitis)^[4,5]Cardiac (constrictive pericarditis)^[6]and pericoronary pseudotumor^[7]Etc. Since IgG4-related cardiovascular disease significantly affects the prognosis of patients, its early diagnosis and treatment are particularly important.