Syvänne M
Department of Medicine, Division of Cardiology, Helsinki University Central Hospital, PO Box 340, 00029 HUS, Finland.
Heart Fail Monit. 2001;1(3):83-6.
Clinical suspicion of congestive heart failure (CHF) always requires a careful diagnostic workup. This comprises the verification of the presence of CHF (in contrast to other conditions that cause nonspecific phenomena such as shortness of breath and edema), evaluation of the underlying cause of heart failure, and assessment of left ventricular (LV) systolic function. In addition to clinical examination, echocardiography is warranted in most cases. On the basis of this information, patients can be selected for further studies, such as exercise testing, cardiac catheterization and coronary angiography. In view of the serious prognosis of heart failure, especially systolic CHF, the threshold for specialist consultation should be low. Although the classification of CHF into systolic and diastolic forms is complex, clinically meaningful data can be derived simply by determining whether LV systolic function is impaired (predominantly systolic CHF) or not (probable diastolic CHF). In the latter case, treatment is mainly symptomatic in addition to the management of the underlying condition (e.g. hypertension). In systolic CHF, considerable therapeutic advances have recently been made and it is important that patients receive appropriate care to improve their prognosis. These measures include angiotensin-converting enzyme inhibitors, beta-blockers and spironolactone.
临床上怀疑充血性心力衰竭（CHF）时，总是需要进行仔细的诊断检查。这包括确认CHF的存在（与其他导致诸如呼吸急促和水肿等非特异性现象的疾病相鉴别）、评估心力衰竭的潜在病因以及评估左心室（LV）收缩功能。除临床检查外，大多数情况下还需要进行超声心动图检查。基于这些信息，可以选择患者进行进一步的检查，如运动试验、心导管检查和冠状动脉造影。鉴于心力衰竭，尤其是收缩性CHF的严重预后，专科会诊的门槛应该较低。虽然将CHF分为收缩性和舒张性形式很复杂，但通过简单确定LV收缩功能是否受损（主要为收缩性CHF）或未受损（可能为舒张性CHF），就可以得出具有临床意义的数据。在后一种情况下，除了治疗潜在疾病（如高血压）外，治疗主要是对症治疗。在收缩性CHF中，最近取得了相当大的治疗进展，重要的是患者要接受适当的治疗以改善预后。这些措施包括血管紧张素转换酶抑制剂、β受体阻滞剂和螺内酯。
