2004-2005 Guidelines for Treatment of Acute Heart Failure (JCS 2006) h Y 2006 11 1 2 2-1 2-2 3 3-1 3-2 1 2 2-1 2-212 2-3 2-4 X 2-5 3ICUCCU 3-1 3-2 3-3 3-4 1 1-1 1-2 1-3 1-4 1-5 2 3 4 4-1 4-2 4-3 1
2004-2005 4-4 4-5 4-6 4-7 5 5-1ACLS 5-2 5-3IABP, PCPS, 5-4 5-5 5-6 5-7 1 2 3 4 5 1 2 3 4 5 5-1 5-2 ACCAmerican College of Cardiology ACEangiotensin converting enzyme ACLSAdvanced Cardiovascular Life Support ACTaccelerated coagulation time AHAAmerican Heart Association AMIacute myocardial infarction APTTactivated partial thromboplastin time ARBangiotensin receptor blocker ATPadenosine triphosphate 3 BLSBasic Life Support BNPbrain natriuretic peptide BSAbody surface area Cacalcium campcyclic adenosine monophosphate CCUcoronary care unit CHDFcontinuous hemodiafiltration CIcardiac index CKcreatine kinase CPAPcontinuous positive airway pressure CRTcardiac resynchronization therapy CVVHcontinuous veno-venous hemofiltration - DCMdilated cardiomyopathy ECUMextracorporeal ultrafiltration method FIO2inspired oxygen fractional concentration hanphuman atrial natriuretic peptide HDhemodialysis HRheart rate IABPintraaortic balloon pumping ICUintensive care unit INRinternational normalized ratio ISDNisosorbide dinitrate LVASleft ventricular assist system LVEFleft ventricular ejection fraction NIPPVnoninvasive positive pressure ventilation NYHANew York Heart Association PCIpercutaneous coronary intervention PCPSpercutaneous cardiopulmonary support PCWPpulmonary capillary wedge pressure 2
PDperitoneal dialysis PDEphosphodiesterase PEEPpositive end-expiratory pressure PTprothrombin time QOLquality of life SVRsystemic vascular resistance V-Aveno-arterial VAPventilator-associated pneumonia ZEEPzero end-expiratory pressure 2000 Japanese Circulation Journal 64 Suppl1129-1165 ACLS 3
2004-2005 a b A B C 4
1 6 1 X X 90 % Paget NYHANew York Heart Association 2acute myocardial infarction, AMI Killip 3 Forrester 1a 2 21 Framingham Study 4 5 22 6 Killip Forrester mmhg - - * -1 - - -2 90 90-18 mmhg 5
2004-2005 s m 50 % 50 % 90 mmhg a. Forrester b. L/min/m 2 2.2 0 hypovolemic shock cardiogenic shock 18 mmhg dry-warm A dry-cold L wet-warm B wet-cold C Na 2 1 2 16 cmh2o 25 13 120 5 4.5 kg 1 1 6
1 2 a b c 3 4 5 6 7 8 9 10 11 12 13 14 15 a b c d e f g h i j k 16 a b c d e f Paget 3 31 BNP Nohria Profile A 1b 32 2 1 1 2 3 3 2 21 1 5 Killip 3 5 2 3 7
2004-2005 95 90 mmhg BLS ACLS FiO2 NIPPVIPPV X 12 Swan-Ganz 2 4 Swan-Ganz 7AMI Swan-Ganz Forrester, 1a Nohria 8
4 1b 3 8 C C C 22 12 3 23 BNP 100 pgml 24 Kerley s B lineperibronchial perivascular cuffing sign vanishing tumor 25 31 Swan-Ganz 7 Forrester 1a 8 1 CK-MB T I A 2 SaO2 C a Swan-Ganz B Swan-Ganz B C C b C 32 9
2004-2005 3 1 4 6 11 4 33 12 6 34 6 9 13 10 14 6 a B S0 Killip 3Nohria 1b Forrester 1a PDE IABPPCPSLVAS S1 X BNP ACE ARB S2 NYHA 2QOL BNP X peak VO2 6 ACE ARB 10
SaO295 %PaO280 mmhg C B B C C Ca C C C C NIPPV C a NIPPV A B PDE A C C b PDE A B B C K C PDE 4-4 a C 4-6 SaO295 %PaO280 mmhg C NIPPV C C C PDE C IABPPCPS C B 2-2.5 C a NIPPV A B C a B PDE a B 15 ACCAHA D CRT C 5 2 11 3 12 4 41 5-10 mga 10 2 mg 3 11
2004-2005 NIPPV PDE PDE ECUMCHDFIABPPCPSLVAS C C CPAPBiPAP NIPPVa A 18 C A C C C B B C Ca C C C CCU C b B C C Fowler a C C A C Swan- Ganz b C C 40 ml C 1 1-1.5 kg C Ca a C C b C 95-98 % CPAPNIPPV C 12
15 b, B 3 4-3 42 43 13 1 1 1 2 2 B NYHA-- B a B C b 1 B C B K K 5.0 meql 1 ISDN 16-24 ISDN C 2 Na a B 1415 0.025-0.05gkgmin 0.0125gkgmin 0.05-0.1gkg min 0.2 gkgmin a B 3 PDE camp PDE camp inodilator 4-4 4 13
2004-2005 a C 15 44 Ca 1 1 1 2 5gkg min 10gkgmin a C 910 2 2gkgmin 2-10gkgmin 10-20 gkgmina C 910 AMI 3 2 a C AMI WPW K Ca 3 PDE 6 PDE 9 a C b B 4 PDE inodilator PDE 9 b C 14 45 1, 2 90 mmhg 3 90 mmhg, 2-5gkgmin, IABP PCPS, 4 70 mmhg 14
50 40 CI 30 20 iv-olp n32 hanp n 30 iv-mil60 n31 oral-pim240' n11 DA ID n 9 DBn 17 DAn 17 10 0 oral-pra n 6 iv-amn90' n 30 HR: heart rate mbp: mean blood pressure SVR: systemic vascular resistance PCWP: pulmonary capillary wedge pressure CI: cardiac index SVI: stroke volume index DA: dopamine, 2-5g/kg/min DB: dobutamine, 2-5g/kg/min 50 40 30 20 10 PCWP AMN90': amrinone 1 mg/kg loading 10g/kg/min 90 MIL60': milrinone 50g/kg loading 0.5g/kg/min 60 PIM240': pimobendan 0.25mg 90 DA ID: dopamine 3-5 ISDN 2mg/hr PRA: prazosin 1 mg hanp: carperitide 0.1g/kg/min OLP: olpurinone 10g/kg loading 0.3g/kg/min amrinone 2006 0 5-10 mga 2-5 mg 3 20-120 mg 2-5 mghr 0.125-0.25 mg 0.5-1.0 ngml 0.5-20gkgmin5gkgmin 2-5gkgmin 5gkgmin 0.5-20gkgmin5gkgmin 0.03-0.3gkgmin 50gkg loading 0.25-0.75gkgmin 10gkg loading 0.1-0.3gkgmin 0.1-0.25gkgmin 0.5-10gkgmin 1-8 mghr0.5-3.3gkgmin 0.5gkgmin 0.5-3gkgmin 0.025gkgmin 0.0125gkgmin0.2 gkgmin 0.05-0.1gkgmin 15
2004-2005 46, IABP PCPS ACE ARB 15 47 ACE ARB A a B b C A a B 16 ATP 2 1 2ATP 16
5 51 17 11 C B B C 18 C B a NIPPV A 0.5-2.0gkgmin C 50 % PaO2 60 mmhg NIPPV PCWP 50 %PEEP 0ZEEP PaO2 80 mmhg 18 mmhg X 1 200 ml ZEEP 40 % PaO2 80 mmhg CPAP NIPPV 53 52 1 1 NIPPV 18 PEEP 19 2 SaO295 %PaO280 mmhg C NIPPV C NIPPV C a NIPPV A 19 24 IABP PCPS 20 Norman NYHA 90 mmhg 2 Lminm 2 20 mmhg IABP B IABPPCPS C a B 17
2004-2005 2 7 21 1 AMI NYHA IV90 mmhg2.0 Lminm 2 20 mmhg PCI AMI IABPPCPS IABP PCPS BSA 1.5 m 2 18
a b c d 2 IABP PCI supported PCI LVAS PT INR 2.5-3.5 100-300 mg 200 mg 1-2 APTT 1.5-2 10 Ukg 2 : 3-2 DCM, a ACT 200-250 a b c d 3-1 BSA 1.5 m 2 20 kg 3-3 bridge to transplant 'bridge to recovery' 7 54 a C 1 biventricular pacing NYHA QRS 19
2004-2005 130 msec EF 35 % 2 22 1 2 3 4 2 5Mobitz 1-2 33-4 4 5 6 torsade de pointes 55 1 23 45 humoral mediator 23 b 1 aextracorporeal ultrafiltration method: ECUM B bcontinuous veno-venous hemofiltration: CVVH B 2 ahemodialysis: HD B bperitoneal dialysis: PD B 3 acontinuous hemodiafiltration: CHDF C 56 1 C 2 21 22 57 1 oozing blow-out pulseless electrical activity PCPS 2 5-3 IABP IABP 3 IABP PCPS 20
C Ca ACE ARB C C 1 3 AMI A AMI C AMI 8 2 1-11-4 4 25 24 Ca ACE ARB PCI Swan-Ganz IABPPCPS IABPPCPS LVAS Ca 24 21
2004-2005 IABPPCPS C b C C C 5 a ACE B ARB B C C C C C 5-3 1 26 B B b C 2 Cockcroft 3 cardiorenal anemia syndrome 27 3 3.0 mgdl 1 B a B a B PDE a C 4 4 9 9 22
A 1 2 3 2 3 B A C 1 3 4 2-1 -1-a -1-b -1-c -2 VAP C D E F G 1-3 4 or 2 3MRSA 1or 2or 4 1or 2 - or 1-3 4 2 C 3 4 1 VAP -- or 2 3 2 VAP - or or or -3 H - 5 51 1 23 16 1 0.5 mg 3-4 0.04 mgkg Mobitz QRS a C 2 12 AMI 2.5-5 mg 5 b C common type b C b C 23
2004-2005 3 a C b C 52 Ca a C QOL 48 16 1 2 28 3 4-22 28 4 5 5 13 14 9 C Ca C a Ca C b C 24
29 1314 1 2 3 4 24 5 48 6 7 29 C a PDE C b PDE C ACE ACE ARB 30 30 31 b ACE ARB C C 1 2 35 8 10-12 CPAP NIPPV a b a Ca IABP PCPS a PDE a 25
2004-2005 a PCPSLVAS 578 21 a PEEP 300-500 ml 70 mmhg 70-90 mmhg 5-1520gkgmin 0.03-0.3gkgmin 5-1520gkgmin 0.03-0.3gkgmin IABPPCPS 26
90 mmhg PDE IABP LVAS ACLS up to date 1 2 34 5 6 AC QOL ACC AHA 2001, 2005 ESC 2005 27