268.4 📌 章末速蚘

268.4.0.0.1 Classification
  • HFrEF (EF ≀ 40), HFmrEF (41-49), HFpEF (≥ 50), HFimpEF (recovered)
268.4.0.0.2 Stages (ACC/AHA)
  • A (at risk) → B (pre-HF) → C (HF symptoms) → D (advanced)
268.4.0.0.3 NYHA
  • I (no limitation), II (slight), III (marked), IV (rest)
268.4.0.0.4 Pathophysiology
  • Neurohormonal activation (RAAS + sympathetic — maladaptive)
  • Cardiac remodeling (dilation + hypertrophy + fibrosis)
  • Natriuretic peptides counter-regulatory
268.4.0.0.5 HFrEF Etiologies
  • Ischemic > DCM (idiopathic + familial + alcohol + chemo + viral) > valvular > others
268.4.0.0.6 HFpEF Etiologies
  • HTN > aging > obesity > DM > AF > restrictive CM (amyloid) > HCM
268.4.0.0.7 Symptoms / Signs
  • Dyspnea + orthopnea + PND + fatigue + edema; elevated JVP, S3 (HFrEF) / S4 (HFpEF), crackles, hepatomegaly
268.4.0.0.8 Diagnosis
  • Echo + BNP / NT-proBNP + ECG + CXR + comprehensive labs + etiology workup
268.4.0.0.9 BNP
  • < 100 unlikely HF; > 400 likely HF; NT-proBNP age-adjusted
268.4.0.0.10 ADHF Phenotypes
  • Wet + Warm (most common) → diuretic
  • Wet + Cold → diuretic + inotrope
  • Dry + Cold → inotrope
  • Dry + Warm → optimize chronic Tx
268.4.0.0.11 ADHF Management
  • IV diuretics + oxygen + NIV (severe pulm edema) + vasodilator (HTN) + inotrope (low-output) + mechanical support (refractory)
268.4.0.0.12 2022 Universal HF Definition (Lancet)
  • Symptoms + signs + objective evidence (BNP/NT-proBNP OR imaging)
268.4.0.0.13 盧醫垫 hint
  • HFpEF: heterogeneous syndrome — comprehensive workup (echo + cardiac MRI + amyloid screen + AF management)
  • HFrEF etiology: distinguish ischemic vs non-ischemic (coronary angiography + cardiac MRI)
  • ADHF triggers: 90% have identifiable trigger; address
  • BNP: useful for ED diagnosis + chronic monitoring
  • HF recovery (HFimpEF): continue GDMT lifelong (TRED-HF)