Understanding acute heart failure: pathophysiology and diagnosis
Understanding acute heart failure: pathophysiology and diagnosis
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DOI：
10.1093/eurheartj/suw044
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发表时间：
2016-11-01
影响因子：
1.6
通讯作者：
Mebazaa, Alexandre
中科院分区：
文献类型：
--
作者：
Arrigo, Mattia;Parissis, John T.;Mebazaa, Alexandre
急性心力衰竭（AHF）是一个相关的公共卫生问题，导致大多数65岁或以上的患者计划外住院。AHF在历史上被描述为泵故障，导致下游灌注不足和上游充血。在过去的几十年中，一个更复杂的网络的相互作用已被添加到简单的血液动力学模型来解释AHF的病理生理。此外，AHF不是一种特殊的疾病，而是不同的、异质性心脏异常的共同临床表现，AHF持续不良结局可能与这些患者的急性管理缺乏改善有关。事实上，AHF的急性治疗仍然主要包括静脉利尿剂和/或血管扩张剂，根据初始血液动力学状态定制，很少考虑潜在的病理生理学特性。因此，有一个未得到满足的需要，增加个性化的AHF治疗根据主要的潜在病理生理机制，希望能改善患者的outcome.In这篇文章中，我们回顾了目前的知识，病理生理学和初步诊断的AHF。
Acute heart failure (AHF) is a relevant public health problem causing the majority of unplanned hospital admissions in patients aged of 65 years or more. AHF was historically described as a pump failure causing downstream hypoperfusion and upstream congestion. During the last decades a more complex network of interactions has been added to the simplistic haemodynamic model for explaining the pathophysiology of AHF. In addition, AHF is not a specific disease but the shared clinical presentation of different, heterogeneous cardiac abnormalities.Persistence of poor outcomes in AHF might be related to the paucity of improvements in the acute management of those patients. Indeed, acute treatment of AHF still mainly consists of intravenous diuretics and/or vasodilators, tailored according to the initial haemodynamic status with little regard to the underlying pathophysiological particularities. Therefore, there is an unmet need for increased individualization of AHF treatment according to the predominant underlying pathophysiological mechanisms to, hopefully, improve patient's outcome.In this article we review current knowledge on pathophysiology and initial diagnosis of AHF.