Introduction
Idiopathic cardiomyopathyAccording to clinical and pathological changes, it can be divided into dilated cardiomyopathy (ie, congestive cardiomyopathy), hypertrophic cardiomyopathy, restrictive or constrictive cardiomyopathy, which are common in the past two categories. The dilated cardiomyopathy ventricle is mainly left ventricular dilatation, and the ventricular end-diastolic volume is increased, resulting in myocardial contractile dysfunction. Clinical manifestations include heart failure, enlarged heart, and often arrhythmia and embolism. The cause is unknown, and it is recently believed to be related to viral myocarditis in the past.
1. No obvious history of viral myocarditis.
2, except for other heart diseases, such as congenital heart disease, rheumatic heart disease, hereditary metabolic diseases, secondary and endemic cardiomyopathy, and the possibility of chronic constrictive pericarditis.
3. Have at least one of the following:
(1) The heart is enlarged, especially the X-ray examination, the heart is spherically enlarged and there is no other reason to explain.
(2) Congestive heart failure, unable to find other heart disease.
(3) ECG shows ST segment and T wave changes or various arrhythmias without other reasons to explain.
(4) There is a fainting episode with a heart enlargement and no other causes.
(5) Circulatory arterial embolization of the body (or lung), for no other reason to explain.
Two-dimensional echocardiography is currently the main diagnostic tool, which can show abnormalities such as heart enlargement, cardiac hypertrophy and valve activity in multiple directions and multiple cuts. Cardiac diagnosis and identification of tube angiography and endocardial myocardial biopsy are helpful for diagnosis, but they are invasive and difficult to carry out extensively.
Hypertrophic cardiomyopathy
The basic pathological changes in the ventricular muscle, especially the interventricular septum hypertrophy, the ventricular cavity becomes smaller, the dynamic left ventricular outflow obstruction, ventricular diastolic function and wall compliance decrease, often due to severe arrhythmia and sudden death; some cases ventricular uniformity Hypertrophy, no left ventricular outflow tract stenosis, so the former is called obstructive hypertrophic cardiomyopathy, the latter is called non-obstructive hypertrophic cardiomyopathy. Some cases have a genetic predisposition and can also be found in certain syndromes such as Noonan syndrome.
Restrictive cardiomyopathy
rare. Endocardial myocardial fibrosis mainly, ventricular cavity became smaller, ventricular systolic and diastolic were affected, mainly diastolic dysfunction. The clinical manifestation of right heart reflow disorder is similar to constrictive pericarditis.
Disease treatment
There is no specific treatment for this disease, mainly symptomatic treatment, which can delay the development of the disease and reduce the occurrence of complications.
Dilated cardiomyopathy
1, bed: heart failure or heart enlargement must be in bed for 3 to 6 months, if the heart still does not shrink, that should continue to stay in bed for more than 1 year.
2, limit sodium salt: obvious heart failure limit sodium salt below 0.5 ~ 1g / day, heart failure control can give 1 ~ 2g / day low salt diet.
3, control heart failure: see the chapter on heart failure. It should be noted that the dose of digitalis should be small, 1/2 to 1/3 of the general dose; diuretics should choose a strong diuretic, such as furosemide or intravenous bolus.
4, applicationAdrenocorticotropic hormoneAdrenal cortex hormones may be used in patients with severe atrioventricular block, difficult heart failure, or suspected autoimmune disease.Prednisone2mg/kg·d, oral, reduction after 2 weeks, 6 to 8 weeks to discontinue.
5, anti-thrombosis: severe heart failure or combined with atrial fibrillation, give anti-platelet agglutination drugs such asDipyridamole(Pan Shengding); if there is embolization, can give anticoagulant or thrombolytic agent.
Hypertrophic cardiomyopathy
1, β-adrenergic receptor blocker: multi-purposePropranolol(Heart Dean) oral administration of 1 ~ 2mg / kg · d, gradually increased to 3 ~ 4mg / kg · d, blood pressure, heart rate, adverse reactions should be followed.
2, calcium antagonists: including verapamil (icopidine), diltiazem table (thiol table ketone), etc., can not only change left ventricular diastolic function, but also reduce left ventricular outflow tract obstruction. Verapamil dose of 1 ~ 2mg / kg · d orally, is generally considered to be superior to propranolol.
3, improve myocardial metabolism drugs: vitamins B, C, adenosine triphosphate (ATP),Coenzyme Q10, polarized solution (glucose-insulin-potassium solution).
4, anti-arrhythmia: such as amiodarone can prevent and treat sudden cardiac arrhythmia.
5, disable positive inotropic drugs: disable digitalis, β-adrenergic receptor stimulants and other positive inotropic drugs.
6, surgical treatment: poor medical treatment, significant obstruction, obvious symptoms, left ventricular outflow tract and aortic peak pressure difference greater than 6.65kPa (50mmHg), should consider surgical removal of hypertrophic muscle to relieve obstruction, short-term efficacy, Long-term efficacy has different opinions, and the operative mortality rate is about 10%.
7, double-chamber cardiac pacing and intra-coronary chemical ablation can reduce left ventricular outflow obstruction, and is increasingly receiving clinical attention.
Restrictive cardiomyopathy
Control heart failure, symptomatic treatment.
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