"Heart failure"의 두 판 사이의 차이
| 9번째 줄: | 9번째 줄: | ||
*[[심초음파]] | *[[심초음파]] | ||
===Stage=== | ===Stage=== | ||
| − | *AHA and ACC | + | *[[AHA]] and [[ACC]] |
| − | *NYHA | + | **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]] | ||
==급성 심부전== | ==급성 심부전== | ||
2017년 9월 18일 (월) 10:28 판
임상 양상
- dyspnea, orthopnea, nocturnal dyspnea, Cheyne-Stokes respiration, 교대맥, S3 gallop
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
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), 심장이식 등
- 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