急性心力衰竭

最后审阅: 26 八月 2022
最后更新: 11 三月 2022

小结

定义

病史和体格检查

关键诊断因素

  • 呼吸困难
  • 外周水肿
  • 运动耐量减低
  • 疲劳
  • 肢端寒冷
  • 颈静脉压升高。
  • 危险因素
  • 心尖搏动位置偏移
  • 奔马律(第三心音)
完整详情

其他诊断因素

  • 夜间咳嗽
  • 哮鸣音
  • 头晕
  • 意识模糊
  • 食欲不振
  • 夜间缺血性疼痛
  • 腹水
  • 中心型紫绀
  • 脉压差小
  • 精神状态改变
  • 少尿
  • 毛细血管再充盈延迟
  • 肺部捻发音
  • 叩诊浊音/肺底空气进入量减少
完整详情

危险因素

  • 既往心血管疾病
  • 老年
  • 心力衰竭既往发作史
  • 糖尿病
  • 缺血性心脏病或心肌病家族史
  • 酒精摄入过量
  • 吸烟
  • 心律失常
  • 与心力衰竭相关的全身性疾病病史
  • 既往化疗
  • 药物治疗
  • 高血压
  • 心脏瓣膜病
  • 心包疾病
  • 心肌炎
  • 盐摄入过多
  • 过多的儿茶酚刺激
  • 甲状腺功能异常
完整详情

诊断性检查

首要检查

  • 心电图(ECG)
  • 胸部 X 线检查
  • 利尿钠肽
  • 肌钙蛋白水平
  • 全血细胞计数
  • 尿素、电解质和肌酐
  • 血糖和 HbA1c
  • 肝功能检测
  • 甲状腺功能检测
  • C 反应蛋白
  • D-二聚体
  • 超声心动图
完整详情

需考虑的检查

  • 静脉或动脉血气检查
  • 通过血液检验筛查心肌炎
  • 床旁胸部超声
完整详情

治疗流程

急症处理

血流动力学不稳定:低血压(收缩 BP <90 mmHg)或其他心源性休克体征

血流动力学不稳定:高血压危象

血流动力学稳定

持续性治疗

稳定后的急性发作:LVEF ≤40%

急性发作后的稳定期:LVEF 41% 至 49%

稳定的急性发作期:LVEF≥50%

撰稿人

专家顾问

Resham Baruah, MBBS, BSc, FRCP, MSc, PhD

Consultant Cardiologist

Heart Failure Lead

Chelsea and Westminster Hospital and the Royal Brompton and Harefield NHS Trust

London

UK

简介

RB was a specialist advisor to the National Institute for Health and Care Excellence guideline on chronic heart failure in adults.

利益声明

RB has received honorarium/speaker fees from Novartis and Boehringer Ingleheim.

Adam D. Hartley, MBBS, BSc, MRCP

Wellcome Trust Clinical Research Fellow

Imperial College London

Specialist Registrar in Cardiology

Imperial College Healthcare NHS Trust

London

UK

利益声明

ADH declares that he has no competing interests.

鸣谢

Best Practice would like to gratefully acknowledge the previous expert contributor, whose work is retained in parts of the content:

Syed Wamique Yusuf, MBBS, FACC, FRCPI

Professor of Medicine

Department of Cardiology

University of Texas

MD Anderson Cancer Center

Houston

TX

同行评议者

Lisa Anderson, BSc, MB, ChB, MD

Consultant Cardiologist

Cardiovascular Clinical Academic Group

Molecular and Clinical Sciences Research Institute

St George's, University of London

St George's University Hospitals NHS Foundation Trust

London

UK

利益声明

LA was deputy chair for the British Society of Heart Failure clinical advisory board for tafamidis, undertook consultancy services for tafamidis (Pfizer), received a research grant from Pfizer, was on the clinical advisory board for dapagliflozin (AstraZeneca), and received lecture fees from the British Society of Cardiology/AstraZeneca and Pfizer.

James Gamble, BM, BCh, DM, FRCP

Consultant Cardiologist

Oxford Heart Centre

John Radcliffe Hospital

Oxford

UK

利益声明

JG has been reimbursed for delivering educational meetings by: Novartis, the manufacturer of sacubitril/valsartan; Boerhinger Ingelhiem, the manufacturer of empagliflocin; AstraZeneca, the manufacturer of dapagliflozin; and Medtronic, the manufacturer of implantable cardioverter defibrillator (ICD) and cardiac resynchronisation therapy (CRT) devices. He has been supported to attend educational meetings by Abbott, Medtronic, and Boston Scientific, who all manufacture ICD and CRT devices. All of these companies produce drugs or devices related to the treatment of heart failure.

编辑

Susan Mayor,

Lead Section Editor, BMJ Best Practice

利益声明

SM works as a freelance medical journalist and editor, video editorial director and presenter, and communications trainer. In this capacity, she has been paid, and continues to be paid, by a wide range of organisations for providing these skills on a professional basis. These include: NHS organisations, including the National Institute for Health and Care Excellence, NHS Choices, NHS Kidney Care, and others; publishers and medical education companies, including the BMJ Group, the Lancet group, Medscape, and others; professional organisations, including the British Thoracic Oncology Group, the European Society for Medical Oncology, the National Confidential Enquiry into Patient Outcome and Death, and others; charities and patients’ organisations, including the Roy Castle Lung Cancer Foundation and others; pharmaceutical companies, including Bayer, Boehringer Ingelheim, Novartis, and others; and communications agencies, including Publicis, Red Healthcare and others. She has no stock options or shares in any pharmaceutical or healthcare companies; however, she invests in a personal pension, which may invest in these types of companies. She is managing director of Susan Mayor Limited, the company name under which she provides medical writing and communications services.

Annabel Sidwell,

Section Editor, BMJ Best Practice

利益声明

AS declares that she has no competing interests.

Rachel Wheeler,

Lead Section Editor, BMJ Best Practice

利益声明

RW declares that she has no competing interests.

Julie Costello,

Comorbidities Editor, BMJ Best Practice

利益声明

JC declares that she has no competing interests.

Adam Mitchell,

Drug Editor, BMJ Best Practice

利益声明

AM declares that he has no competing interests.

专家顾问:合并症

Martyn Patel, BMBcH, FRCP, MA

Consultant, Older People's Medicine

Norfolk and Norwich University Hospitals

NHS Foundation Trust

Norwich

UK

利益声明

MP is a contributor to the Oxford Textbook of Otolaryngology, Oxford University Press, 2021, having written a chapter about mental capacity law, for which he received no fee. MP is the NHS representative on the board for Norwich Institute for Healthy Ageing (unpaid role). MP has spoken at the International Forum on Quality and Safety in Healthcare, virtual conference in November 2020 for which he received no fee. MP has accepted speaker fees and/or travel expenses to deliver lectures from: University of East Anglia, Leicester University (speaker fees only); Astellas Pharma Ltd (speaker fees and travel expenses). MP has accepted travel expenses from Newton Europe to present a joint project conducted by his main employer (Norfolk and Norwich University Hospitals NHS Trust) and Newton Europe at the NHS Confederation conference (Manchester 2018).

Andrew Lewington, BSc (Hons), MBBS, MEd, MD, FRCP

Consultant Renal Physician

Honorary Associate Professor

Nephrology Department

Leeds Teaching Hospitals NHS Trust

Leeds

UK

利益声明

AL is Associate Clinical Director of NIHR Leeds In-Vitro Diagnostics Co-operative, Co-Chair of UK Kidney Research Consortium Renal Clinical Study Group, Member of Kidney Research UK Research Grant Committee, Committee Member of NICE Kidney Injury Clinical Guideline Update 2018-20, Committee Member of NICE Diagnostic Assessment for Point of Care Creatinine Testing 2018-19. AL attended the Acute Dialysis Quality Initiative Meeting in San Diego 2018 (accommodation expenses); AL was a speaker at the AKI & CRRT Conference in San Diego 2019 (travel and accommodation expenses), the AKI Conference in Coventry 2019 (travel expenses), and the NIHR AKI and Sepsis Meeting in Leeds 2019 (no expenses).

Martin Cowie, MD, MSc, FRCP, FRCP (Ed), FESC, FHFA, FACC

Professor of Cardiology

Imperial College London (Royal Brompton Hospital)

London

UK

利益声明

MC is chair of the European Society of Cardiology Digital Health Committee and a trustee of the Atrial Fibrillation Society. He has previously been a non-executive director of the National Institute for Health and Care Excellence. MC provides consultancy advice to AstraZeneca, Servier, Abbott, Medtronic, Boston Scientific, & Genomics PLC. MC declares that none of these interests is directly related to topics advised on for this project.

Rachael Evans, MBChB, FRCP (UK), PhD

Associate Professor (Clinical)

University of Leicester

Honorary Consultant Respiratory Physician

Glenfield Hospital

Leicester

UK

利益声明

RAE has given lectures for non-promotional industry-led sessions on COPD management, including for GSK and Chiesi for individual payment and travel expenses totalling <£2,000.

Gerry Rayman, MD, FRCP

Consultant Physician and Head of Service

Diabetes and Endocrine Centre and the Diabetes Research Unit

Ipswich Hospitals NHS Trust

Ipswich

UK

利益声明

GR has been paid for advisory board meetings with the following companies: Safoni Aventis, Abbott Diabetes UK, Lilly Diabetes, Bayer. GR has received lecture fees from Safoni Aventis, Abbott Diabetes UK, Lilly Diabetes, Novonordisk, Napp Pharmaceuticals Ltd.

Sotiris Posporelis, MD, MRCPsych

Consultant Liaison Neuropsychiatrist

King’s College Hospital

South London and Maudsley NHS Foundation Trust

Honorary Senior Clinical Lecturer

Institute of Psychiatry, Psychology & Neuroscience

King’s College London

London

UK

利益声明

SP declares that he has no competing interests.

Asangaedem Akpan, MPH, FRCP

Consultant Geriatrician

Liverpool University Hospitals NHS Foundation Trust

Visiting Professor

University of Cumbria

Carlisle

Honorary Clinical Associate Professor

University of Liverpool

Liverpool

UK

利益声明

AA declares that he has no competing interests.

同行评议:合并症

Martyn Patel, BMBcH, FRCP, MA

Consultant, Older People's Medicine

Norfolk and Norwich University Hospitals

NHS Foundation Trust

Norwich

UK

利益声明

MP is a contributor to the Oxford Textbook of Otolaryngology, Oxford University Press, 2021, having written a chapter about mental capacity law, for which he received no fee. MP is the NHS representative on the board for Norwich Institute for Healthy Ageing (unpaid role). MP has spoken at the International Forum on Quality and Safety in Healthcare virtual conference in November 2020, for which he received no fee. MP has accepted speaker fees and/or travel expenses to deliver lectures from: University of East Anglia, Leicester University (speaker fees only); Astellas Pharma Ltd (speaker fees and travel expenses). MP has accepted travel expenses from Newton Europe to present a joint project conducted by his main employer (Norfolk and Norwich University Hospitals NHS Trust) and Newton Europe at the NHS Confederation conference (Manchester 2018).

  • 急性心力衰竭 images
  • omorbidities

    添加患者合并症,即刻获取定制管理计划

  • 鉴别诊断

    • 肺炎
    • 肺栓塞
    • 哮喘
    更多 鉴别诊断
  • 指南

    • ESC有关急性和慢性心力衰竭诊断和治疗的指南
    • 急性心力衰竭:诊断和管理
    更多 指南
  • 患者教育信息

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    心力衰竭:询问医生

    更多 患者教育信息
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