最后审阅: 12 四月 2021
最后更新: 16 三月 2021

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

撰稿人

Consultant Cardiologist

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

London

UK

利益声明

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

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.

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

同行评议者展开全部内容

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.

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.

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.

Section Editor, BMJ Best Practice

利益声明

AS declares that she has no competing interests.

Lead Section Editor, BMJ Best Practice

利益声明

RW declares that she has no competing interests.

Comorbidities Editor, BMJ Best Practice

利益声明

JC declares that she has no competing interests.

Drug Editor, BMJ Best Practice

利益声明

AM declares that he has no competing interests.

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