The Role of the Clinical Examination in Patients With Heart Failure
The Role of the Clinical Examination in Patients With Heart Failure
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DOI：
10.1016/j.jchf.2018.04.005
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发表时间：
2018-07-01
影响因子：
13
通讯作者：
Drazner, Mark H.
中科院分区：
文献类型：
--
作者：
Thibodeau, Jennifer T.;Drazner, Mark H.
尽管生物标志物和技术取得了进步，但临床检查（即病史和体格检查）仍然是心力衰竭患者治疗的核心。具体地，临床检查允许基于患者是否具有升高的心室充盈压和/或心脏指数不足来无创地评估患者的潜在血液动力学状态。此类评估提供重要的预后信息并有助于指导治疗决策。在此，作者批判性地评估了临床检查对于这些目的的实用性，并提供了我们从晚期心力衰竭领域的实践中收集到的实用技巧。作者指出，评估充血的能力优于评估灌注不足的能力。此外，在目前的实践中，左心室充盈压升高是通过与右心房压力升高相关的发现来推断的。他们讨论了临床检查中出现的一种分类系统，该系统根据心室充盈压升高是否发生在右侧、左侧或两侧对患者进行分类。 (C) 2018 年，美国心脏病学会基金会。
Despite advances in biomarkers and technology, the clinical examination (i.e., a history and physical examination) remains central in the management of patients with heart failure. Specifically, the clinical examination allows noninvasive assessment of the patient's underlying hemodynamic state, based on whether the patient has elevated ventricular filling pressures and/or an inadequate cardiac index. Such assessments provide important prognostic information and help guide therapeutic decision-making. Herein, the authors critically assess the utility of the clinical examination for these purposes and provide practical tips we have gleaned from our practice in the field of advanced heart failure. The authors note that the ability to assess for congestion is superior to that for inadequate perfusion. Furthermore, in current practice, elevated left ventricular filling pressures are inferred by findings related to an elevated right atrial pressure. They discuss an emerging classification system from the clinical examination that categorizes patients based on whether elevation of ventricular filling pressures occurs on the right side, left side, or both sides. (C) 2018 by the American College of Cardiology Foundation.