醫週譯:Heart failure / 心臟衰竭

Heart failure (HF), often used to mean chronic heart failure (CHF), occurs when the heart is unable to pump sufficiently to maintain blood flow to meet the needs of the body.[1][2][3] The terms congestive heart failure (CHF) or congestive cardiac failure(CCF) are often used interchangeably with chronic heart failure.[4] Symptoms commonly include shortness of breath, excessive tiredness, and leg swelling.[5] The shortness of breath is usually worse with exercise, when lying down, and at night while sleeping.[5]There is often a limitation on the amount of exercise people can perform, even when well treated.[6]

’’’心臟衰竭’’’({{lang-en|HF, heart failure}}),一般意指’’’慢性心臟衰竭’’’({{lang-en|CHF, chronic heart failure}}),當[[心臟]]無法推送足量{{link-en|blood flow|血流}}維持身體所需,心臟衰竭於焉而生<ref>{{DorlandsDict|four/000047501|heart failure}}</ref><ref>{{cite web |title=Heart failure |date=23 December 2009 |work=Health Information |id=DS00061 |publisher=Mayo Clinic |url=http://www.mayoclinic.com/health/heart-failure/DS00061}}</ref><ref>{{cite web |title=Definition of Heart failure |date=27 April 2011 |work=Medical Dictionary |publisher=MedicineNet |url=http://www.medterms.com/script/main/art.asp?articlekey=3672}}</ref>。在醫學術語中,’’’鬱血性心衰竭’’’({{lang-en|CHF, congestive heart failure}},又稱{{lang-en|CCF, congestive cardiac failure}})或’’’慢性心臟衰竭’’’({{lang-en|CHF, chronic heart failure}})同義且可互換使用<ref>{{cite web|title=Living Well With Chronic Heart Failure|url=http://www.heartfoundation.org.au/SiteCollectionDocuments/Living-well-with-chronic-heart-failure.pdf|work=Heart Foundation|accessdate=25 May 2014|page=18}}</ref>。心臟衰竭症狀通常包含[[呼吸困難]]、[[疲倦|過度疲憊]]與[[外週性水腫|下肢水腫]]<ref name=NICEChp1/>。呼吸喘特別在[[運動]]、{{link-en|Orthopnea||

平躺}}與{{link-en|Paroxysmal nocturnal dyspnoea|

夜間睡眠}}時容易症狀加劇<ref name=NICEChp1>{{cite journal|title=Chronic Heart Failure: National Clinical Guideline for Diagnosis and Management in Primary and Secondary Care: Partial Update|journal=National Clinical Guideline Centre|date=Aug 2010|pages=19–24|pmid=22741186}}</ref>。心臟衰竭通常會限制病患行動與運動的可負荷量,即便控制得宜,運動量依然受限<ref name=McD2011/>。

<!-- Causes -->

Common causes of heart failure include coronary artery disease including a previous myocardial infarction (heart attack), high blood pressure, atrial fibrillation, valvular heart disease, and cardiomyopathy.[5][7] These cause heart failure by changing either the structure or the functioning of the heart.[5] There are two main types of heart failure: heart failure due to left ventricular dysfunction and heart failure with normal ejection fraction depending on if the ability of the left ventricle to contract is affected, or the heart’s ability to relax.[5] The severity of disease is usually graded by how much the ability to exercise is decreased.[8] Heart failure is not the same as myocardial infarction (in which part of the heart muscle dies) or cardiac arrest (in which blood flow stops altogether).[9][10]Other diseases that may have symptoms similar to heart failure include: obesity, kidney problems, liver problems, anemia andthyroid disease among others.[8]

<!-- 成因 -->

造成心臟衰竭的常見原因包括[[冠狀動脈性心臟病|冠狀動脈疾病]](包含曾有[[心肌梗塞]])、[[高血壓]]、[[心房顫動]]、{{link-en|Valvular_heart_disease|瓣膜性心臟病}}、和{{link-en|Cardiomyopathy|心肌病變}}<ref name=NICEChp1/><ref name="Lancet2005">{{cite journal |author=McMurray JJ, Pfeffer MA |title=Heart failure |journal=Lancet |volume=365 |issue=9474 |pages=1877–89 |year=2005 |pmid=15924986 |doi=10.1016/S0140-6736(05)66621-4 }}</ref>。這些原因會造成心臟結構或功能的改變,進而造成心臟衰竭<ref name=NICEChp1/>。根據[[心室|左心室]]{{link-en|Ejection_fraction|射出分率}}({{lang-en|LVEF, left ventricular ejection fraction}})異常與否,心臟衰竭分為兩類:低收縮分率心衰竭({{lang-en|HFrEF, heart failure with reduced ejection fraction}})和正常收縮分率心衰竭({{lang-en|HFpEF, heart failure with preserved ejection fraction}})<ref name=NICEChp1/>,兩者的病理機轉不同,對藥物治療反應與預後亦不相同。疾病嚴重程度通常以運動耐受力下降多寡來分級<ref name=NICEChp4/>。心臟衰竭並不等同於心肌梗塞(部份心肌壞死)或[[心停止|心跳停止]](所有血流皆停止)<ref>{{cite book|title=Willard & Spackman’s occupational therapy.|date=2014|publisher=Wolters Kluwer Health/Lippincott Williams & Wilkins|location=Philadelphia|isbn=9781451110807|page=1124|url=http://books.google.it/books?id=zLh3h6v5O_0C&pg=PA1124|edition=12th ed.}}</ref><ref>{{cite book|title=The Cardiac Care Unit Survival Guide|date=2012|publisher=Lippincott Williams & Wilkins|isbn=9781451177466|page=98|url=http://books.google.it/books?id=ZvkUJZCoi2EC&pg=PA98|author=Eyal Herzog}}</ref>。其他可能和心臟衰竭有類似症狀的疾病包括:[[肥胖]]、腎臟問題、肝臟問題、[[貧血]]、{{link-en|Thyroid_disease|甲狀腺疾病}}等<ref name=NICEChp4/>。

<!-- Treatment -->

The condition is diagnosed based on the history of the symptoms and a physical examination with confirmation by echocardiography.[11] Blood tests, electrocardiography, and chest radiography may be useful to determine the underlying cause.[11]Treatment depends on the severity and cause of the disease.[11] In people with chronic disease already in a stable situation, treatment commonly consists of lifestyle measures such as stopping smoking,[12] physical exercise,[13] and dietary changes, as well as medications.[12] In those with heart failure due to left ventricular dysfunction, angiotensin converting enzyme inhibitors and beta blockers are recommended.[11] For those with severe disease, aldosterone antagonists, an angiotension receptor blocker orhydralazine with a nitrate may be used.[11] If there is a normal ejection fraction, associated health problems should be treated.[11]Diuretics are useful for preventing fluid retention and thus recommended.[12] Sometimes, depending on the cause, an implanted device such as a pacemaker or implantable cardiac defibrillator may be useful.[11] A ventricular assist device or occasionally a heart transplant may be recommended in those with severe disease despite all other measures.[12]

<!-- 療法 -->

心臟衰竭的診斷是根據病史及理學檢查,並透過[[心臟超音波]]確認診斷<ref name=NICEChp3/>。[[血液檢查|抽血檢查]]、[[心電圖]]、{{link-en|胸部X光攝影|Chest radiograph}}則適用決定心臟衰竭的潛在成因<ref name=NICEChp3/>。心臟衰竭的治療端視嚴重度與成因。對控制穩定的慢性心臟衰竭病患而言,治療通常包含藥物、生活型態的調整,譬如[[戒菸]]<ref name=NICEChp5/>、[[體能鍛鍊|運動]]<ref name=Taylor2014>{{cite journal|last=Taylor|first=RS|coauthors=Sagar, VA; Davies, EJ; Briscoe, S; Coats, AJ; Dalal, H; Lough, F; Rees, K; Singh, S|title=Exercise-based rehabilitation for heart failure.|journal=The Cochrane database of systematic reviews|date=Apr 27, 2014|volume=4|pages=CD003331|pmid=24771460}}</ref>、飲食控制等<ref name=NICEChp5/>。對低收縮分率心衰竭病患而言,建議使用藥物包含[[血管緊張肽I轉化酶抑制劑|血管張力素轉化酶抑制劑]]與{{link-en|乙型交感神經接受體阻斷劑|Beta blockers}}<ref name=NICEChp3>{{cite journal|title=Chronic Heart Failure: National Clinical Guideline for Diagnosis and Management in Primary and Secondary Care: Partial Update|journal=National Clinical Guideline Centre|date=Aug 2010|pages=34–47|pmid=22741186}}</ref>。對於較嚴重者,可使用[[抗鹽皮質激素|醛固酮拮抗劑]]、[[血管紧张素II受体拮抗剂|血管張力素受體抑制劑]]或[[肼屈嗪|肼苯太素]]併用{{link-en|硝酸鹽類|Nitrovasodilator}}<ref name=NICEChp3/>。對正常收縮分率心衰竭患者,則需要治療相關健康問題<ref name=NICEChp3/>。[[利尿劑]]因為有助於避免體液滯留,所以建議服用。必要時視情況,則可使用[[心律調節器]]或{{link-en|植入型去顫器|Implantable cardioverter-defibrillator}}<ref name=NICEChp3/>。然而嚴重患者對上述治療反應不佳,可考慮{{link-en|心室輔助器|Ventricular assist device}}或[[心臟移植]]<ref name=NICEChp5>{{cite journal|title=Chronic Heart Failure: National Clinical Guideline for Diagnosis and Management in Primary and Secondary Care: Partial Update|journal=National Clinical Guideline Centre|date=Aug 2010|pages=71–153|pmid=22741186}}</ref>。

<!-- Epidemiology and History-->

Heart failure is a common, costly, and potentially fatal condition.[7] In developed countries, around 2% of adults have heart failure and in those over the age of 65, this increases to 6–10%.[7][14] In the year after diagnosis the risk of death is about 35% after which it decreases to below 10% each year.[5] This is similar to the risks with a number of types of cancer.[5] In the United Kingdom the disease is the reason for 5% of emergent hospital admissions.[5] Heart failure has been known since ancient times with the Ebers papyrus commenting on it circa 1550 BCE.[6]

<!-- 流行病學與歷史-->

心臟衰竭是常見、高醫療支出且可能致命的疾病<ref name="Lancet2005"/>。在已開發國家,約2%的成人有心臟衰竭,而年齡高於65歲者則增加至6-10%<ref name="Lancet2005"/><ref name="pmid18799522">{{cite journal |author=Dickstein K, Cohen-Solal A, Filippatos G, et al. |title=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) |journal=Eur. Heart J. |volume=29 |issue=19 |pages=2388–442 |date=October 2008 |pmid=18799522 |doi=10.1093/eurheartj/ehn309 |url=http://eurheartj.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=18799522}}</ref>。甫診斷心臟衰竭第一年的死亡風險為35%,往後每年則降低至10%<ref name=NICEChp1/>。此風險與某些癌症類似<ref name=NICEChp1/>。在英國心臟衰竭佔緊急入院的5%<ref name=NICEChp1/>。有關心臟衰竭的文獻,最早由{{link-en|埃伯斯紙草文稿|Eber papyrus}}紀錄於西元前1550年<ref name=McD2011>{{cite book|last=McDonagh|first=Theresa A.|title=Oxford textbook of heart failure|date=2011|publisher=Oxford University Press|location=Oxford|isbn=9780199577729|page=3|url=http://books.google.it/books?id=r8wowXxC1voC&lpg=PP1}}</ref>。

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