Akut Kalp Yetersizliği
Özet
Akut kalp yetersizliği (AKY), kalp yetersizliği belirti ve bulgularının acil müdahale veya hastaneye yatış gerektirecek düzeyde hızla ya da tedricen şiddetlenmesi olarak tanımlanan ve özellikle yaşlı popülasyonda yüksek mortaliteye yol açan ciddi bir kardiyovasküler tablodur. Genellikle kronik kalp yetersizliğinin dekompansasyonu veya yeni başlayan bir yetersizlik şeklinde gelişen bu patolojide; koroner arter hastalıkları, ritim bozuklukları, kapak patolojileri ve hipertansiyon gibi etkenler rol oynar. Fizyopatolojisinde azalan sistolik/diyastolik fonksiyonlar nörohumoral sistemleri aktive ederek vazokonstriksiyon, tuz-su tutulumu ve pulmoner konjesyona neden olur. Tanı sürecinde ekokardiyografi, elektrokardiyografi, natriüretik peptidler ve temel laboratuvar testleri kritik önem taşır. Klinik olarak dekompanse kalp yetersizliği, akut akciğer ödemi, izole sağ ventrikül yetersizliği ve kardiyojenik şok tabloları görülebilir. Tedavinin temelini sıvı yükünü azaltan loop diüretikleri oluştururken; hastanın hemodinamik durumuna göre oksijen desteği, vazodilatatörler, inotroplar, vazopressörler ve ECMO gibi mekanik dolaşım destek sistemleri kullanılır.
Acute heart failure (AHF) is a critical cardiovascular condition defined as a rapid or gradual worsening of heart failure signs and symptoms severe enough to require emergency department visits or hospitalization, resulting in high mortality particularly among the elderly. Often manifesting as the decompensation of chronic heart failure or as de novo onset, it is triggered by coronary artery disease, rhythm disturbances, valvular pathologies, and hypertension. Pathophysiologically, impaired systolic or diastolic functions activate neurohumoral systems, leading to vasoconstriction, sodium-water retention, and pulmonary congestion. Echocardiography, electrocardiography, natriuretic peptides, and basic laboratory tests are vital for diagnosis. Clinically, it presents as acute decompensated heart failure, acute pulmonary edema, isolated right ventricular failure, or cardiogenic shock. Although loop diuretics aimed at fluid overload remain the cornerstone of management, treatments also involve oxygen therapy, vasodilators, inotropes, vasopressors, and mechanical circulatory support such as ECMO based on the patient's hemodynamic status.
Referanslar
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