Cardiovascular Emergencies

Akut Kalp Yetmezliği
Acute Heart Failure
Alp ŞENERa, Ayhan ÖZHASENEKLERa
aAnkara Yıldırım Beyazıt ÜniversitesiAnkara Şehir Hastanesi, Acil Tıp ABD, Ankara, Türkiye
Şener A, Özhasenekler A. Akut kalp yetmezliği. Yürümez Y, editör. Kardiyovasküler Aciller. 1. Baskı. Ankara: Türkiye Klinikleri; 2022. p.60-7.
Article Language: TR
ÖZET
Geniş bir spektrumda karşımıza çıkabilen akut kalp yetmezliği kliniğinde, %30'lara varan 1 yıllık mortalite oranlarından bahsedilmektedir. Özellikle pulmoner ödem ve kardiyojenik şok tablolarında hızlı tanıma ve müdahale önem arz etmektedir. Bir yandan diüretikler ve nitrat grubu ajanlarla akut tedaviye başlarken diğer yandan presipite eden faktörlerin de irdelenmesi ve geri dönüşlü nedenlerin ortadan kaldırılması gerekmektedir. Elektrokardiyografi ve ekokardiyografi temel tanı araçlarından olup natriüretik peptitler de en önemli laboratuvar parametresi olarak değerlendirilmektedir. Yönetim, akut kalp yetmezliği tiplerine göre farklılıklar gösterse de özellikle loop diüretiklerin tedavinin temel taşı olduğu bilinmektedir. Bunun yanında da vazodilatörler, vazopresörler ve inotroplar kalp yetmezliğinin tipine ve hastaya spesifik olmak üzere sıkça kullanılmaktadır. Gerek oksijen tedavisi gerekse pozitif basınçlı ventilasyon yöntemleri ve mekanik dolaşım desteği cihazları hasta spesifik olarak kullanımı önerilen araçlardır. Akut kalp yetmezliği ve atriyal fibrilasyon birlikteliği sık görülmektedir; bu hastalarda da antikoagülasyon, hız ve ritim kontrolü basamakları kılavuzlara uygun ilerlemelidir. Akut kalp yetmezliği mortalitesi yüksek olmakla birlikte acil servislerde hızlı ve etkin tedavi ile yüz güldürücü sonuçların alınabildiği önemli bir hastalıktır. Hasta yönetiminde, birçok basamaktaki uygulamalar için güncel kanıt düzeylerinin yetersiz olduğu ve bu basamaklar üzerinde çalışmaya açık birçok parametre olduğu görülmektedir.

Anahtar Kelimeler: Pulmoner ödem; şok, kardiyojenik; diüretikler; sürekli pozitif havayolu basıncı
ABSTRACT
In acute heart failure clinic, which can be encountered in a wide spectrum, 1-year mortality rates are expressed as 30%. Rapid recognition and intervention are important, especially in cases of pulmonary edema and cardiogenic shock. Initially, while starting acute treatment with diuretics and nitrate group agents, on the other hand, the precipitating factors should be examined and reversible causes should be eliminated. Electrocardiography and echocardiography are basic tools, and natriuretic peptides are considered as the most important laboratory parameter. Although the management differs according to the types of acute heart failure, especially loop diuretics are considered to be the cornerstone of treatment. In addition, vasodilators, vasopressors and inotropes are frequently used as type and patient specific. Both oxygen therapy, positive pressure ventilation methods and mechanical circulatory support devices are also recommended for patient use under certain conditions. Coexistence of acute heart failure and atrial fibrillation is common; anticoagulation, rate and rhythm control steps should be followed in accordance with the guidelines in such patients. Although acute heart failure has a high mortality rate, satisfactory outcomes can be obtained with rapid and effective treatment in emergency services. It is seen that the current level of evidence is insufficient for the drugs and interventions in the vast majority of the management steps and there are many parameters on these steps that need to be studied.

Keywords: Pulmonary edema; shock, cardiogenic; diuretics; continuous positive airway pressure

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