小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
- 劳力性呼吸困难
其他诊断因素
- 端坐呼吸
- 阵发性夜间呼吸困难
- 腹胀
- 啰音
- 颈静脉怒张
- 肝颈静脉回流征
- 充血性肝肿大
- 下肢水肿
- 心尖搏动向外侧移位
- 奔马律
危险因素
- 高血压
- 女性
- 年龄＞70 岁
- 肥胖
- 冠状动脉疾病/缺血
- 糖尿病
- 慢性肾病
- 心肌和心包疾病
- 阻塞性睡眠呼吸暂停
诊断性检查
首要检查
- 血清电解质
- 肾功能检查
- 肝酶
- B型脑钠肽（BNP）/氨基端B型脑钠肽前体（NT-pro-BNP）
- 全血细胞计数 (FBC）
- 12 导联心电图
- 胸部 X 线检查 (CXR)
- 多普勒超声心动图
- 组织多普勒成像（TDI）
需考虑的检查
- 心脏磁共振 (CMR) 成像
- CT 血管造影术
- 放射性核素心室造影术（MUGA扫描）
- 负荷试验
- 心脏导管检查和冠状动脉造影术
治疗流程
急性失代偿性 HFpEF
慢性 HFpEF
撰稿人
作者
Gerald Carr-White, PhD, FRCP
Consultant Cardiologist
Guys and St Thomas’ NHS Foundation Trust
London
UK
利益声明
GCW has been reimbursed by Pfizer, Astra Zenica, Bayer, Medtronic, St Jude, and Sanofi for attending conferences. He has attended Advisory Boards for Medtronic, St Jude, Novartis, Shire, Sanofi and Servier, and has a joint working venture with Novartis for a community pharmacist post.
Jessica Webb, BM, BCh, MA, MRCP, FHEA
Cardiology Specialist Registrar
Guys and St Thomas’ NHS Foundation Trust
London
UK
利益声明
JW declares that she has no competing interests.
鸣谢
Dr Gerald Carr-White and Dr Jessica Webb would like to gratefully acknowledge Dr Gerard Aurigemma, Dr Lokesh Tejwani, Dr Marc E. Del Rosario, and Dr Kul Aggarwal, previous contributors to this topic. GA, LT, MEDR, and KA declare that they have no competing interests.
同行评议者
Edward Geltman, MD
Professor of Medicine
Cardiovascular Division
Washington University School of Medicine
St. Louis
MO
利益声明
EG has lectured for Novartis, Forest, Merck, and Pfizer.
Jerry Murphy, MB, BS, DM, FRCP
Consultant Cardiologist
Darlington Memorial Hospital
Darlington
UK
利益声明
Not disclosed.
鉴别诊断
- 收缩性心力衰竭
- 阻塞型肺病
- 特发性肺动脉高压
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