행위

"Heart failure"의 두 판 사이의 차이
 
(같은 사용자의 중간 판 16개는 보이지 않습니다)
1번째 줄: 1번째 줄:
 
[[분류:Disease]] [[분류:Cardiology]]
 
[[분류:Disease]] [[분류:Cardiology]]
−
[[심부전]](Heart failure)
+
[[심부전]](Heart failure, [[HF]])
  
 
==임상 양상==
 
==임상 양상==
−
*dyspnea, orthopnea, nocturnal dyspnea, Cheyne-Stokes respiration, 교대맥, S3 gallop
+
*[[dyspnea]], [[orthopnea]], [[nocturnal dyspnea]], [[Cheyne-Stokes respiration]], [[교대맥]], [[S3 gallop]]
  
 
==진단==
 
==진단==
 
*[[BNP]]
 
*[[BNP]]
 +
**< 100 pg/mL - HF unlikely
 +
**>400 pg/mL - HF likely
 +
**100-400 pg/mL - Use clinical judgment
 
*[[심초음파]]
 
*[[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]]
 +
  
  
78번째 줄: 117번째 줄:
 
===치료===
 
===치료===
 
*Stage 별 치료 진행
 
*Stage 별 치료 진행
−
**[[salt restriction]], 운동 -> ACEi, BB -> AB+[[digitalis]], [[diuretics]] -> 기계적 보조장치(biventricular pacing), 심장이식 등
+
**[[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
 
*생존율 증가 약제
−
**[[ACEi]], [[ARB]]
+
**[[ACEi]]: NYHA class II 이상에서 1st line
 +
**[[ARB]]: ACEi를 사용할 수 없는 경우 1st line
 
**[[BB]] 중 [[carvedilol]], [[bisoprolol]], [[metoprolol]]
 
**[[BB]] 중 [[carvedilol]], [[bisoprolol]], [[metoprolol]]
 +
***acute HF에서는 악화시킬 수 있어 주의
 
**Aldosterone antagonist: [[spironolactone]], [[eplerenone]]
 
**Aldosterone antagonist: [[spironolactone]], [[eplerenone]]
 +
***NYHA class III 이상에서만 이득
 
**Direct vasodilator: [[hydralazine]]+[[isosorbide dinitrate]]
 
**Direct vasodilator: [[hydralazine]]+[[isosorbide dinitrate]]
−
*폐부종, 체액 저류시: [[diuretics]] 우선 사용
+
*[[폐부종]], 체액 저류시: [[diuretics]] 우선 사용
 
**[[furosemide]]: 모든 HF에서 효과적
 
**[[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

심부전(Heart failure, HF)

임상 양상

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
    • 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

  • 만성 심부전의 급성악화나 허혈성 심질환, 고혈압 등 다른 기저 질환에 의해 생김

치료


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

예후 인자

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