heart failure(心臟衰竭)

症狀/併發症(symptom/complication)	@心室重塑(ventricular remodeling) @#Jugular vein distention, JVD 資料來源：clinicalexams @Hepatojugular reflux, HJR: give a stable pressure at patient's abdomen, if Jugular vein pressure keep rising, that's may be right heart failure @gallop rhythm: abnormal S3 heart sound: note!!S3 in baby is normal @edema: usually accompany weight gain @perfusion: limbs blood reduce and looks pale complication @complete left bundle branch block, CLBBB(心臟左束支傳導完全阻滯) @arrhythmia(心律不整)
病因(etiology)	|cardio output deficiency-->stimulate sympathetic nerve-->cardiace muscle contraction increase-->pulse increase and cardiac muscle hypertrophy-->muscarinic receptor will down regulation due to continuously stimulate--> some cardiac cell death--> contraction have some problem other classification ||Systolic dysfunction: Difficulty emptying the left ventricle. 50~70% |||Reduced ejection fraction (< 40%) ||Diastolic dysfunction: Inability to fill and relax the left ventricle. 20~50% ||Elevated end diastolic pressure ||Normal sized chamber other etiology classification |cardiomyopathy |myocardial ischemia and infarction |hypertension |cardiac valve disease |coronary artery disease
檢查/準則(examination/criteria)	#end stage-->NYHA: III、IV; ACC/AHA-->D #New York Heart association classification of heart failure, NYHA-->based on symptoms ##Class I (Mild): No limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, or dyspnea (shortness of breath). ##Class II (Mild): Slight limitation of physical activity. Comfortable at rest, but ordinary physical activity results in fatigue, palpitation, or dyspnea. ##Class III (Moderate): Marked limitation of physical activity. Comfortable at rest, but less than ordinary activity causes fatigue, palpitation, or dyspnea. ##Class IV (Severe): Unable to carry out any physical activity without discomfort. Symptoms of cardiac insufficiency at rest. If any physical activity is undertaken, discomfort is increased. 資料來源：abouthf #ACC/AHA ##A:Patients at high risk of developing HF because of the presence of conditions that are strongly associated with the development of HF. Such patients have no identified structural or functional abnormalities of the pericardium, myocardium, or cardiac valves and have never shown signs or symptoms of HF ##B: Patients who have developed structural heart disease that is strongly associated with the development of HF but who have never shown signs or symptoms of HF ##C: Patients who have current or prior symptoms of HF associated with underlying structural heart disease ##D: Patients with advanced structural heart disease and marked symptoms of HF at rest despite maximal medical therapy and who require specialized interventions. 資料來源：美國心臟科醫學會 #腦排鈉利尿胜肽(Brain Natriuretic Peptide, BNP): >100 pg/ml abnormal #Electrolyte #Ultrasound #ECG
治療(treatment)	$drug first $$diuretics, an old treatment: Vicious Cycle of Heart Failure Management 資料來源：clevelandclinicmeded $$ACE-1 blocker or ARB: ACC/AHA A $$beta blocker $$ACE-1 and beta blocker: ACC/AHA B $$CRT, ACE-1 and beta blocker: : ACC/AHA C $$digoxin: only improve patients life quality, do not decrease mortality $surgery and only used for end-stage HF $$VAD: : ACC/AHA D $$心臟再同步化治療(Cardiac resynchronization therapy, CRT) $$CRT-D: CRT + ICD(Implantable Cardioverter Defibrillator) ICD 資料來源：美國國立衛生研究院 $heart failure can use surgery to resolve $$Left ventricular failure $$Obstruction of Coronary arteries $$Ischemic Mitral incompetence $$Left ventricular ANeurysm 資料來源：dhzb $moderate exercise
鑑別診斷(Differential Diagnosis)
流行病學(Epidemiology)	+CRT can increase 4 years survival rate +1 year mortality is about 45~50% +highly sudden cardiac death(心臟猝死) +prevalence is relatively high: due to well-control of other chronic disease such as DM, hypertension 資料來源：國家健康與臨床卓越研究所

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