"Heart failure"의 두 판 사이의 차이
(같은 사용자의 중간 판 20개는 보이지 않습니다) | |||
1번째 줄: | 1번째 줄: | ||
[[분류:Disease]] [[분류:Cardiology]] | [[분류:Disease]] [[분류:Cardiology]] | ||
− | [[심부전]](Heart failure) | + | [[심부전]](Heart failure, [[HF]]) |
+ | ==임상 양상== | ||
+ | *[[dyspnea]], [[orthopnea]], [[nocturnal dyspnea]], [[Cheyne-Stokes respiration]], [[교대맥]], [[S3 gallop]] | ||
+ | |||
+ | ==진단== | ||
+ | *[[BNP]] | ||
+ | **< 100 pg/mL - HF unlikely | ||
+ | **>400 pg/mL - HF likely | ||
+ | **100-400 pg/mL - Use clinical judgment | ||
+ | *[[심초음파]] | ||
+ | ===Stage=== | ||
+ | *[[AHA]] and [[ACC]] | ||
+ | **Stage A | ||
+ | ***People at high risk of developing heart failure (pre-heart failure), including people with: | ||
+ | ****[[High blood pressure]] | ||
+ | ****[[Diabetes]] | ||
+ | ****[[Coronary artery disease]] | ||
+ | ****[[Metabolic syndrome]] | ||
+ | ****History of cardiotoxic drug therapy | ||
+ | ****History of [[alcohol abuse]] | ||
+ | ****History of [[rheumatic fever]] | ||
+ | ****Family history of [[cardiomyopathy]] | ||
+ | **Stage B | ||
+ | ***People who have developed structural heart disease that is strongly associated with the development of heart failure (such as those with a history of heart attack, those with a low ejection fraction, valve disease with no symptoms) but without signs and symptoms of heart failure. | ||
+ | **Stage C | ||
+ | ***Patients with known systolic heart failure and current or prior symptoms(Shortness of breath, Fatigue, Reduced ability to exercise) | ||
+ | **Stage D | ||
+ | ***Patients with systolic heart failure and presence of advanced symptoms after receiving optimum medical care | ||
+ | *[[NYHA]] | ||
+ | **Stage I | ||
+ | ***No limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, dyspnea (shortness of breath). | ||
+ | **Stage II | ||
+ | ***Slight limitation of physical activity. Comfortable at rest. Ordinary physical activity results in fatigue, palpitation, dyspnea (shortness of breath). | ||
+ | **Stage III | ||
+ | ***Marked limitation of physical activity. Comfortable at rest. Less than ordinary activity causes fatigue, palpitation, or dyspnea. | ||
+ | **Stage IV | ||
+ | ***Unable to carry on any physical activity without discomfort. Symptoms of heart failure at rest. If any physical activity is undertaken, discomfort increases. | ||
==급성 심부전== | ==급성 심부전== | ||
+ | *만성 심부전의 급성악화나 허혈성 심질환, 고혈압 등 다른 기저 질환에 의해 생김 | ||
+ | |||
+ | ===치료=== | ||
+ | *Warm & Wet: [[acute pulmonary edema]]에 준해 치료(MAIL DONi) | ||
+ | **[[Diuretics]], [[vasodilator]]; [[nitrate]], [[nitroprusside]] | ||
+ | *Cold & Wet: [[Cardiogenic shock]]에 준해 치료 | ||
+ | **IV [[vasodilator]], [[dobutamine]], [[dopamine]](low dose) | ||
+ | *Cold & dry: PCWP<12이면 [[수액 보충]] | ||
+ | |||
69번째 줄: | 114번째 줄: | ||
| +(persistent) | | +(persistent) | ||
|} | |} | ||
+ | |||
+ | ===치료=== | ||
+ | *Stage 별 치료 진행 | ||
+ | **[[salt restriction]], 운동 -> ACEi, BB -> AB+[[digitalis]], [[diuretics]] -> 기계적 보조장치([[biventricular pacing]], CRT), 심장이식 등 | ||
+ | **[[Biventricular pacing]] indication | ||
+ | ***Sinus rhythm with EF <35% | ||
+ | ***QRS > 120ms | ||
+ | ***Symptomatic CHF(NYHA class III-IV | ||
+ | *생존율 증가 약제 | ||
+ | **[[ACEi]]: NYHA class II 이상에서 1st line | ||
+ | **[[ARB]]: ACEi를 사용할 수 없는 경우 1st line | ||
+ | **[[BB]] 중 [[carvedilol]], [[bisoprolol]], [[metoprolol]] | ||
+ | ***acute HF에서는 악화시킬 수 있어 주의 | ||
+ | **Aldosterone antagonist: [[spironolactone]], [[eplerenone]] | ||
+ | ***NYHA class III 이상에서만 이득 | ||
+ | **Direct vasodilator: [[hydralazine]]+[[isosorbide dinitrate]] | ||
+ | *[[폐부종]], 체액 저류시: [[diuretics]] 우선 사용 | ||
+ | **[[furosemide]]: 모든 HF에서 효과적 | ||
+ | *부정맥 동반시 | ||
+ | **이뇨제에 의한 hypokalemia 확인 | ||
+ | **[[Amiodarone]]: AF 동반시 TOC | ||
+ | **[[ICD]]: 급사 위험시 예방적 사용 | ||
+ | |||
+ | ===예후 인자=== | ||
+ | *[[NYHA classification]]: 가장 중요 |
2018년 1월 18일 (목) 08:42 기준 최신판
임상 양상
진단
Stage
- AHA and ACC
- Stage A
- People at high risk of developing heart failure (pre-heart failure), including people with:
- High blood pressure
- Diabetes
- Coronary artery disease
- Metabolic syndrome
- History of cardiotoxic drug therapy
- History of alcohol abuse
- History of rheumatic fever
- Family history of cardiomyopathy
- People at high risk of developing heart failure (pre-heart failure), including people with:
- Stage B
- People who have developed structural heart disease that is strongly associated with the development of heart failure (such as those with a history of heart attack, those with a low ejection fraction, valve disease with no symptoms) but without signs and symptoms of heart failure.
- Stage C
- Patients with known systolic heart failure and current or prior symptoms(Shortness of breath, Fatigue, Reduced ability to exercise)
- Stage D
- Patients with systolic heart failure and presence of advanced symptoms after receiving optimum medical care
- Stage A
- NYHA
- Stage I
- No limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, dyspnea (shortness of breath).
- Stage II
- Slight limitation of physical activity. Comfortable at rest. Ordinary physical activity results in fatigue, palpitation, dyspnea (shortness of breath).
- Stage III
- Marked limitation of physical activity. Comfortable at rest. Less than ordinary activity causes fatigue, palpitation, or dyspnea.
- Stage IV
- Unable to carry on any physical activity without discomfort. Symptoms of heart failure at rest. If any physical activity is undertaken, discomfort increases.
- Stage I
급성 심부전
- 만성 심부전의 급성악화나 허혈성 심질환, 고혈압 등 다른 기저 질환에 의해 생김
치료
- Warm & Wet: acute pulmonary edema에 준해 치료(MAIL DONi)
- Cold & Wet: Cardiogenic shock에 준해 치료
- IV vasodilator, dobutamine, dopamine(low dose)
- Cold & dry: PCWP<12이면 수액 보충
만성 심부전
- 확장기 심부전: 나이 많고 고혈압이 있는 비만한 여성에서 흔하다.
확장기 심부전 | 수축기 심부전 | |
---|---|---|
연령 | >70세 | 50~70세 |
성별 | 여자 | 남자 |
좌심실구혈율 | 정상, 40% 이상 | 감소, 40% 이하 |
좌심실용적 | 정상 | 증가 |
흉부단순촬영 | 폐울혈 | 심비대, 폐울혈 |
청진 | 제4심음 | 제3심음 |
고혈압 | ++++ | ++ |
당뇨 | +++ | ++ |
심근경색 병력 | + | +++ |
비만 | +++ | + |
만성 폐질환 | ++ | 0 |
수면무호흡증 | ++ | ++ |
장기적투석 | ++ | 0 |
심방세동 | +(paroxysmal) | +(persistent) |
치료
- Stage 별 치료 진행
- salt restriction, 운동 -> ACEi, BB -> AB+digitalis, diuretics -> 기계적 보조장치(biventricular pacing, CRT), 심장이식 등
- Biventricular pacing indication
- Sinus rhythm with EF <35%
- QRS > 120ms
- Symptomatic CHF(NYHA class III-IV
- 생존율 증가 약제
- ACEi: NYHA class II 이상에서 1st line
- ARB: ACEi를 사용할 수 없는 경우 1st line
- BB 중 carvedilol, bisoprolol, metoprolol
- acute HF에서는 악화시킬 수 있어 주의
- Aldosterone antagonist: spironolactone, eplerenone
- NYHA class III 이상에서만 이득
- Direct vasodilator: hydralazine+isosorbide dinitrate
- 폐부종, 체액 저류시: diuretics 우선 사용
- furosemide: 모든 HF에서 효과적
- 부정맥 동반시
- 이뇨제에 의한 hypokalemia 확인
- Amiodarone: AF 동반시 TOC
- ICD: 급사 위험시 예방적 사용
예후 인자
- NYHA classification: 가장 중요