Cardiology
Heart Failure (HFrEF)
박출률감소심부전
Systolic heart failure with LVEF ≤40%
- How common
- 1-2% of adults
- Typical age
- Increases after age 60
What is it?
Myocardial injury (MI, cardiomyopathy) → impaired systolic function → neurohormonal activation (RAAS, sympathetic) → ventricular remodeling → progressive deterioration.
Commonly affected: LV, lungs, kidneys, systemic
How it develops
- Myocardial injuryMI, chronic ischemia, cardiomyopathy
- Reduced contractilityLVEF ≤40%
- Neurohormonal activationRAAS/sympathetic compensation
- Ventricular remodelingDilation, structural change, fibrosis
Symptoms
- Exertional dyspneaGraded by NYHA class
- OrthopneaMultiple pillows needed
- PNDSudden nighttime dyspnea
- Bilateral leg edemaPitting bilateral edema
- Fatigue/reduced exerciseReduced cardiac output
How it is examined
- Cardiac auscultationS3 gallop (specific), pulmonary rales
- Elevated JVPJVP > 8cm
- Hepatojugular refluxSustained JVP rise with abdominal pressure
Imaging
CXR shows cardiomegaly, pulmonary edema, Kerley B lines.
- Cardiomegaly
- Interstitial edema
- Pleural effusion
Echo measures LVEF (≤40% diagnostic); MRI for etiology.
- Reduced LVEF
- Wall motion abnormality
- LV dilation
Non-surgical care
- GDMT quadruple therapyACEi/ARNI + BB + MRA + SGLT2 inhibitor
- Diuretics (symptom relief)Furosemide for volume overload
- Salt/fluid restrictionSalt <2g/day, fluid 1.5-2L/day
- Cardiac rehabSupervised exercise program
- Digoxin (selective)Adjunct for persistent symptoms
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Advanced or refractory to medical therapy
Procedures that may be discussed
- ICD (EF ≤35%)
- CRT (QRS ≥150ms)
- LVAD
- Heart transplant
Outlook
With GDMT, 1-yr mortality 7-10%; advanced HF has ~50% 5-yr mortality.