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Kronisk hjärtsvikt

Senast uppdaterad: Senast reviderad:


Definition: 
Ett komplext kliniskt syndrom med symtom och tecken på att hjärtats minutvolym är för låg i förhållande till kroppens behov. Kan delas in i hjärtsvikt med bevarad ejektionsfraktion (HFpEF), reducerad ejektionsfraktion (HFrEF) och med mellanvärden för ejektionsfraktionen (HFmEF).
Förekomst: 
Prevalensen anges till 1–2 %, det vill säga omkring 100 000–200 000 patienter i Sverige. 
Symtom:
Typiskt är dyspné, ortopné, paroxysmal nattlig dyspné, minskad ansträngningskapacitet, trötthet/fatigue med förlängd tid till återhämtning, bilateralt ankelödem.
Kliniska fynd:
Typiska fynd är halsvenstas, hepatojugulär reflux, tredje hjärtton, lateralt placerad apikal impuls.
Diagnostik: 
En kombination av symtom, tecken, blodprover där BNP/NT-proBNP har särskilt värde samt EKG och ekokardiografi.
Behandling:
Beror på typ av hjärtsvikt. Vid HFrEF/HFmEF är ACE-hämmare, betablockerare, aldosteronantagonister och SGLT-2-hämmare indicerade medan man vid HFpEF mest inriktar sig på grundsjukdomarna. Diuretika kan användas hos alla patienter med tecken på dekompensation. 
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  • Faris Al-Khalili, med dr och specialist i kardiologi, Hjärt-lung- och allergimottagningen, Sophiahemmets sjukhus