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)
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
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
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
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
治疗流程
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
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.
Andrew Lewington, BSc (Hons), MBBS, MEd, MD, FRCP
Consultant Renal Physician
Honorary Associate Professor
Nephrology Department
Leeds Teaching Hospitals NHS Trust
Head of MBChB
School of Medicine
University of Leeds
Leeds
UK
利益声明
AL has been the principal applicant/co-applicant for a number of grants including: Engineering and Physical Sciences Research Council Research - Multiplexed AKI biomarker detection with a single molecule biosensor; Leeds Cares - A novel, non-invasive diagnostic approach to assess kidney transplant health through the targeted measurement of biomarkers of kidney injury and immune response in kidney transplant recipients at the Leeds Teaching Hospitals NHS Trust; Kidney Research Yorkshire - Use of enhanced technology to characterise haemodialysis treatment for acute kidney injury (AKI); Bringing It Home - Validation of a micro-sampling technique for measuring tacrolimus and creatinine remotely; and to fund a research nurse; British Renal Society - Renal function assessment with point of care creatinine in diverse populations (RAPID), and several NIHR grants including on a) Improving the quality of post-discharge care following AKI b) An investigation into the use of remote blood sample collection to reduce health inequalities in patients with mental health disorders c) A comparison of remote blood collection devices: a human factor use study d) Defining the characteristics for a novel automatic device to monitor urine output in catheterized patients e) Leeds Medtech and In-vitro Diagnostic Cooperative Grant Extension f) Surgical MedTech Co-operative for the 2019/20 proof-of-principle funding stream g) A pilot investigation into the use of beta-trace protein for residual renal function estimation in haemodialysis h) Application of functional MRI to improve assessment of chronic kidney disease (AFiRM study) i) SuperResPath-Renal: Quantitative super-resolution technology for a fast, decentralised clinical diagnosis of renal pathologies. AL is the co-author of a number of manuscripts including on extracorporeal treatments, AKI, kidney function testing prior to contrast-enhanced CT, plasma exchange and glucocorticoids in severe ANCA-associated vasculitis, COVID-19 rapid diagnostics, multimodal image-guided ablation on management of renal cancer in Von-Hippel-Lindau syndrome, and on a summary of NICE guidance on CKD. AL is the author of several book chapters on nephrology and AKI. AL has received expenses for accommodation and travel for conferences at which he has given lectures, other than those delivered virtually. AL was a member of the AKI Scientific Program Committee for the ISN World Congress of Nephrology 2020-2021 and Chair of this same committee in 2021-2022.
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 long COVID and provided consultancy for GSK, AstraZenica, Boehringer, and Chiesi, for individual payment and travel expenses totalling <£4000.
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 has received honorariums for giving lectures on behalf of Profile Pharma in 2021. AA is an expert committee member of the National Institute for Health and Care Excellence (NICE) quality standards committee on urinary tract infections in adults and Deputy chair of the British Geriatrics Society England Council and Ageing Specialty Research Lead CRN NWC. AA sits on advisory committees for the following research studies: VOICE2 (development and testing of communication skills training for hospital healthcare practitioners caring for people living with dementia), SWOP (social work in older people) and CFIN (cognitive frailty interdisciplinary network). AA has received research funding from the Liverpool CCG and Applied Research Collaborative. He is contributing to developing a heart failure pathway tool for the British Society for Heart Failure and has been invited to contribute to the European Union Geriatric Medicine conference (free conference registration) and British Society for Heart Failure conference (accommodation and travel expenses covered).
Acknowledgement: Professor Sanjay Agrawal
BMJ Best Practice would like to gratefully acknowledge Professor Sanjay Agrawal, National Speciality Advisor for tobacco dependency at NHS England and Chair of Royal College of Physicians tobacco advisory group, for his advice on the comorbidity content for 'current smoker'.
Professor Sanjay Agrawal, MBChB, FRCP
Consultant in Respiratory and Intensive Care Medicine
University Hospitals of Leicester NHS Trust
Leicester
UK
利益声明
SA 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.
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
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