행위

Heart failure

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