01陈明-心肌病.docVIP

The diagnosis and treatment of chronic heart failure (From ESC Guidelines 2008) Definition of heart failure Many definitions of HF have been put forward over the last 50 years.These highlight one or several features of this complex syndrome such as haemodynamics, oxygen consumption, or exercise capacity. In recent years, most definitions have emphasized the need for both the presence of symptoms of HF and physical signs of fluid retention. HF is a syndrome in which the patients should have the following features: symptoms of HF, typically shortness of breath at rest or during exertion, and/or fatigue; signs of fluid retention such as pulmonary congestion or ankle swelling; and objective evidence of an abnormality of the structure or function of the heart at rest (Table 3). A clinical response to treatment directed at HF alone is not sufficient for the diagnosis, but is helpful when the diagnosis remains unclear after appropriate diagnostic investigations. Patients with HF would usually be expected to show some improvement in symptoms and signs in response to those treatments from which a relatively fast symptomatic improvement could be anticipated (e.g. diuretic or vasodilator administration). The major and common clinical manifestations of HF are shown in Table 4. Asymptomatic structural or functional abnormalities of the heart are considered as precursors of symptomatic HF and are associated with a high mortality. Descriptive terms in heart failure Acute and chronic heart failure Many additional words or phrases are used to characterize patients with HF. These terms can overlap, and physicians do sometimes use words with a slightly different meaning. The word ‘acute’ in the context of acute HF has become confusing because some clinicians use the word to indicate severity (the medical emergency of life-threatening pulmonary oedema) and others use the word to indicate decompensated, recent-onset, or even new-onset HF.4 The word is then an indicator of time rather