急性心力衰竭(AFH)的规范治疗;
一、概述
·65岁，首要的住院病因
·高死亡率：住院4%～10%,出院后1年25~30%
·高再住院率：出院后1年45%再住院或死亡
·新发(更高院内死亡率、较低出院后病死率和再住院率),慢性心力衰竭急性失代偿(约占70%);Characteristic;
心衰类型;
Congestion+;
ApracticalapproachtodifferentiatingAHFS:
-reliesonsystolicBPatthetimeofpresentation
1.Hypertensivegroup:
-female
normalLVEF
-inhospitalmortalityrate-2%
(with5%mortalityand30%readmissionrateswithin60-90daysofdischarge)
2.Normotensivegroup:
-lowLVEF
signsandsymptomsofpulmonary/systemiccongestion(oedema)beforeandatthetimeofadmission
(with7%mortalityand30%readmissionrateswithin60-90daysofdischarge)
3.Hypotensivegroup:
-lowSBPlevels(≤120mmHg)atthetimeofpresentation
-lowLVEFhistoryofHF
(mortalityrate7%duringhospitalizationwith14%mortaliyand30%readmissionrateswithin60-90daysofdischarge);
临床分级：症状严重度
·NYHA心功能分级：症状、运动耐力
·ACCF/AHA分级：结构改变、症状
·Killip分级：心梗后急性状态;
术语;
VolumeOverload
·Dyspneaonexertion
·Orthopnea
·Paroxysmalnocturnaldyspnea(PND)
·Earlysatiety
·Nauseaandvomiting
·Rales
·Peripheraledema·↑Jugularvenous
pressure(JVP)
·(+)Hepatojugularreflex(HJR)
·Hepato-/splenomegaly
·Ascites;
粉红色泡沫痰;;
诊断流程：新发AHF
Patienthistory,signsand/or
symptomssuspectedofacuteHF
·Eectrocardiogram
·Pulseoximetry
·Echocardiography
·lnitiallaboratoryinvestigations
·ChestX-ray
·Lungultrasound
·Ocherspeificevaluationsb
Natriureticpeptidetesting;
心脏;
ECG:主要是排除心衰
异常
·提高心衰诊断概率，特异性低
·病因信息
·治疗适应证
正常
·心衰可能性小，敏感性89%;
超声心动图
广泛用于心衰检查
·明确诊断
·提示病因
·确定适宜治疗;
Goals
·Decermineaotiology
·Aleviatesymptoms
·Improvecongestionandorganperfusion
·Restoreoxygenation
·Limitorgandamage(cardac,renal,hepatic,gut)
·Prevengthromboembolism
·Determineaetlolog