2009年ACCAHA成人心衰指南(部分)分析.doc

2009年ACC/AHA成人心衰指南（部分）1. The diagnosis of HF is primarily based on signs and symptoms derived from a thorough history and physical examination. Clinicians should determine the following:心衰的诊断主要依靠病史询问与体格检查所获取的症状与体征。临床医生应当确定以下情况：（证据级别：C）：a. adequacy of systemic perfusion; 足够的体循环灌注b. volume status; 容量状态c. the contribution of precipitating factors and/or comorbidities; 诱因和/或并发症的影响d. if the heart failure is new onset or an exacerbation of chronic disease; and是否为新发心衰还是慢性心衰恶化；以及e. whether it is associated with preserved ejection fraction. Chest radiographs, electrocardiogram, and echocardiography are key tests in this assessment. (Level of Evidence: C) 射血分数是否保持正常。胸片、心电图和超声心动图是评估中的关键检查项目。2. Concentrations of B-type natriuretic peptide (BNP) or N-terminal pro-B-type natriuretic peptide (NT-proBNP) should be measured in patients being evaluated for dyspnea in which the contribution of HF is not known. Final diagnosis requires interpreting these results in the context of all available clinical data and ought not to be considered a stand-alone test (565,566). (Level of Evidence: A) 对于不清楚呼吸困难否是由心衰所致的患者，应该测定BNP或者NT-proBNP的浓度。最终诊断需要结合所有可获得的临床资料对所得结果进行阐释，而不应将其视为一项独立检查（565，566）。（证据级别：A）3. Acute coronary syndrome precipitating HF hospitalization should be promptly identified by electrocardiogram and cardiac troponin testing, and treated as appropriate to the overall condition and prognosis of the patient. (Level of Evidence: C) 应该通过心电图和肌钙蛋白测定快速识别由急性冠脉综合征诱发的心衰住院，并根据患者的整体状况和预后进行合理的治疗。（证据级别：C）4. It is recommended that the following common potential precipitating factors for acute HF be identified as recognition of these comorbidities is critical to guide therapy: 识别以下引起急性心衰的常见潜在诱因及合并症对指导治疗是至关重要的。（证据级别：C）a. acute coronary syndromes/coronary ischemia; 急性冠脉综合症/冠状动脉缺血b. severe hypertension; 重度高血压c. atrial and ventricular arrhythmias; 房性或室性心律失常d. infections; 感染e. pulmonary emboli; 肺栓塞f. renal failure; and肾衰；以及g. medical or dietary noncompliance. (Level of Evidence: C)