"Heart failure"의 두 판 사이의 차이
| (같은 사용자의 중간 판 3개는 보이지 않습니다) | |||
| 7번째 줄: | 7번째 줄: | ||
==진단== | ==진단== | ||
*[[BNP]] | *[[BNP]] | ||
| + | **< 100 pg/mL - HF unlikely | ||
| + | **>400 pg/mL - HF likely | ||
| + | **100-400 pg/mL - Use clinical judgment | ||
*[[심초음파]] | *[[심초음파]] | ||
===Stage=== | ===Stage=== | ||
| 27번째 줄: | 30번째 줄: | ||
***Patients with systolic heart failure and presence of advanced symptoms after receiving optimum medical care | ***Patients with systolic heart failure and presence of advanced symptoms after receiving optimum medical care | ||
*[[NYHA]] | *[[NYHA]] | ||
| − | *Stage I | + | **Stage I |
| − | **No limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, dyspnea (shortness of breath). | + | ***No limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, dyspnea (shortness of breath). |
| − | *Stage II | + | **Stage II |
| − | **Slight limitation of physical activity. Comfortable at rest. Ordinary physical activity results in fatigue, palpitation, dyspnea (shortness of breath). | + | ***Slight limitation of physical activity. Comfortable at rest. Ordinary physical activity results in fatigue, palpitation, dyspnea (shortness of breath). |
| − | *Stage III | + | **Stage III |
| − | **Marked limitation of physical activity. Comfortable at rest. Less than ordinary activity causes fatigue, palpitation, or dyspnea. | + | ***Marked limitation of physical activity. Comfortable at rest. Less than ordinary activity causes fatigue, palpitation, or dyspnea. |
| − | *Stage IV | + | **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. | + | ***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== | ||
| 114번째 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, CRT), 심장이식 등 | + | **[[salt restriction]], 운동 -> ACEi, BB -> AB+[[digitalis]], [[diuretics]] -> 기계적 보조장치([[biventricular pacing]], CRT), 심장이식 등 |
| − | **Biventricular pacing indication | + | **[[Biventricular pacing]] indication |
***Sinus rhythm with EF <35% | ***Sinus rhythm with EF <35% | ||
***QRS > 120ms | ***QRS > 120ms | ||
| 127번째 줄: | 130번째 줄: | ||
***NYHA class III 이상에서만 이득 | ***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 | *부정맥 동반시 | ||
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