급성 심부전 증후군의 치료
Medical Treatment of Acute Decompensated Heart Failure Syndrome
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초록
급성 심부전 증후군 환자들은 초기 치료가 매우 중요하며울혈 증상 감소를 목적으로 루프계 이뇨제를 신속히 정맥주사해야 한다. 이뇨제 치료에 저항성을 보일 경우에는 ultrafiltration을고려해 볼 수 있으며 심근수축제의 사용은 심박출량이 감소되어 조직으로의 관류가 부족한 경우 일시적으로 사용할 수 있다. 그 외에도 현재 개발 중인 새로운 치료 약제들이 향후 급성 심부전 증후군 환자들의 사망률 및재입원율을 감소시키고 삶의 질을 향상시키는 데 도움이 될수 있을 것이다.
Abstract
Acute decompensated heart failure syndrome is the most common cause of cardiovascular hospitalization with a high rate ofin-hospital mortality. The clinical presentation is characterized by different clinical profiles due to various underlying causes, precipitatingfactors, volume status, and tissue perfusion status. Therefore, clinicians should carefully examine the hemodynamic statusof acute decompensated heart failure patients in the initial management. Risk stratification might provide guidance to clinicianswho care for patients with acute decompensated heart failure syndromes, and might improve decision-making in emergent carewhen decisions must be made quickly and accurately. Intravenous loop diuretics are the main treatment option for the relief of congestivesymptoms. This article reviews how to assess hemodynamic status of acute decompensated heart failure patients and how toperform risk stratification of patients. Additionally, the initial treatment approach with a variety of pharmacological therapies includinginotropic agents, diuretics, beta-blockers, angiotensinogen converting enzyme-inhibitors, angiotensin receptor blockers, digoxin,and other medications that are routinely prescribed in the management of acute decompensated heart failure patients are alsodiscussed.
참고문헌 (16)
- Thom T, "Heart disease and stroke statistics-2006 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee", Circulation, 113, pp.e85~e151 (2006)
- Nohria A, "Clinical assessment identifies hemodynamic profiles that predict outcomes in patients admitted with heart failure", J Am Coll Cardiol, 41, pp.1797~1804 (2003)
- Dickstein K, "ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA)and endorsed by the European Society of Intensive Care Medicine (ESICM)", Eur Heart J, 29, pp.2388~2442 (2008)
- Hunt SA, "2009 Focused update incorporated into the ACC", AHA 2005 Guidelines for the diagnosis and management of heart failure in adults: a report of the American College of Cardiology Foundation, J Am Coll Cardiol, pp.2009, 53[DOI]
- Sanchez CE, "Contemporary in-hospital management strategies for acute decompensated heart failure", Cardiol Rev, 19, pp.122~129 (2011)
- Fonarow GC, "ADHERE Scientific Advisory Committee, Study Group, and Investigators. Risk stratification for inhospital mortality in acutely decompensated heart failure:classification and regression tree analysis", JAMA, 293, pp.572~580 (2005)
- 최동주, "Characteristics, Outcomes and Predictors of Long-Term Mortality for Patients Hospitalized for Acute Heart Failure: A Report From the Korean Heart Failure Registry", Korean Circulation Journal, 41(7), pp.363~371 (2011), 대한심장학회
- Oh J, "Hemoconcentration is a good prognostic predictor for clinical outcomes in acute heart failure: data from the Korean Heart Failure (KorHF)Registry", Int J Cardiol, 168, pp.4739~4743 (2013)
- Oh J, "The CKD-EPI is more accurate in clinical outcome prediction than MDRD equation in acute heart failure: data from the Korean Heart Failure (KorHF) Registry", Int J Cardiol, 167, pp.1084~1087 (2013)
- Hong SJ, "Clinical implication of right bundle branch block in hospitalized patients with acute heart failure: data from the Korean Heart Failure (KorHF)Registry", Int J Cardiol, 157, pp.416~418 (2012)
- Felker GM, "Diuretic strategies in patients with acute decompensated heart failure", N Engl J Med, 364, pp.797~805 (2011)
- Bart BA, "Cardiorenal rescue study in acute decompensated heart failure: rationale and design of CARRESS-HF, for the Heart Failure Clinical Research Network", J Card Fail, 18, pp.176~182 (2012)
- Ezekowitz JA, "Standardizing care for acute decompensated heart failure in a large megatrial: the approach for the Acute Studies of Clinical Effectiveness of Nesiritide in Subjects with Decompensated Heart Failure (ASCEND-HF)", Am Heart J, 157, pp.219~228 (2009)
- Konstam MA, "Effects of oral tolvaptan in patients hospitalized for worsening heart failure: the EVEREST outcome trial", JAMA, 297, pp.1319~1331 (2007)
- Teerlink JR, "Serelaxin, recombinant human relaxin-2, for treatment of acute heart failure (RELAX-AHF): a randomised, placebo-controlled trial", Lancet, 381, pp.29~39 (2013)
- Youn YJ, "Treatment performance measures affect clinical outcomes in patients with acute systolic heart failure: report from the Korean Heart Failure Registry", Circ J, 76, pp.1151~1158 (2012)