心肌疾病(英文)

Abdomen and others
Percussion and palpation of the liver may reveal hepatomegaly due to elevated venous pressure, infiltrative disease, hepatojugular reflux, or ascites Observe for cardiac cachexia, peripheral edema, cyanosis, and clubbing
Inspection and palpation
Palpate for heaves, shifted point of maximal impulse, and cardiomegaly (broad and displaced point of maximal impulse, right ventricular heave). The normal apical impulse should be approximately the size of a quarter and should be located in one (fourth or fifth) intercostal space. The apical impulse is normally within 10 cm of the midsternal line
心肌疾病(英文) tangqizhu tel:88041911-6604 email:qizhut@ renmin hospital wuhanuniversity difinition cardiomyopathy seriousdisease heartmuscle becomes inflamed doesn?twork secondary.primary cardiomyopathy can?t specificcause, highblood pressure, heart valve disease, artery diseases congenitalheart defects. secondary cardiomyopathy specificcauses fourmain types: dilated cardiomyopathy hypertrophic cardiomyopathy restrictive cardiomyopathy arrhythmogenic right ventricular dysplasia impairedcontraction bothventricles importances cardiomyopathyappears reportedincidence 0.013-0.084%cardiomyopathy importantcause mortalityamong world?saging population sex: men/women 2.5/1age: all age groups affected.however, studies suggest newonset youngerthan yearscardiomyopathies have many causes, including nutritional deficiencies, deposits heartmuscle associated medicalconditions, anemia, stress, viral infections, alcoholism, coronary artery disease, identifiablecause, although endstage myocarditissymptoms often develop gr
TESTS FOR DETECTION
To confirm the diagnosis, the physician may order tests, including: Blood tests; Chest x ray; Echocardiogram; Electrocardiography (ECG) Cardiac catheterization and angiography
Medications
Medications may include digitalis, Angiotensin converting enzyme (ACE) inhibitors,Anticoagulants,Betablockers,Calcium channel blockers, Vasodilators ,diuretics, nutritional supplements, or other cardiac medications
Cardiomyopathy and myocarditis
Renmin Hospital of Wuhan University
Tang Qizhu Tel:88041911-6604 Email:qizhut@
Difinition
Cardiomyopathy is a serious disease in which the heart muscle becomes inflamed and doesn't work as well as it should It can be classified as primary or secondary. Primary cardiomyopathy can't be attributed to a specific cause, such as high blood pressure, heart valve disease, artery diseases or congenital heart defects. Secondary cardiomyopathy is due to specific causes
Auscultation
Murmurs (with appropriate maneuvers),tachycardia, S2 at the base (paradoxical splitting, prominent P2), S3, and S4 may be noted An irregularly irregular rhythm (atrial fibrillation) may be noted Gallops are almost always present in persons with DCM
Clasification(1995
WHO/ISFC)
There are four main types: Dilated cardiomyopathy Hypertrophic cardiomyopathy Restrictive cardiomyopathy Arrhythmogenic right ventricular dysplasia
CAUSES
Cardiomyopathies have many causes, including nutritional deficiencies, deposits in the heart muscle associated with medical conditions, anemia, stress, viral infections, alcoholism, coronary artery disease, and others There is no identifiable cause, although it is suspected to be an end stage of myocarditis
Electrocardiogram
ECG changes are usually nonspecific Low voltage complexes Presence of Q waves and inversion of T waves in leads I, II, aVL, and V4 through V6 (anterolateral infarction pattern) Significant arrhythmia
Neck and Lungs
Jugular venous distention (as an estimate of central venous pressure) Hepatojugular reflux Large cv wave (observed with tricuspid regurgitation) Crackles (pulmonary rales) Signs of pleural effusion may be noted
TREATMENTS
Hospitalization may be required of patients when symptoms of dilated cardiomyopathy are severe. Treatment for dilated cardiomyopathy is focused on relief of symptoms, just as is for other types of cardiomyopathy, and is essentially the same as the treatment of heart failure
Dilated cardiomyopathy
This type of cardiomyopathy is characterized by a dilatation and impaired contraction of the left or both ventricles
Importances
DIAGNOSIS
A physician diagnoses dilated cardiomyopathy after a physical examination check for shortness of breath during exercise and weakness The physician may also hear rales, or wet crackles, through a stethoscope, indicating fluid in the lungs
Doppler Echo
Marked dilation of the left ventricle with global hypokinesia is the hallmark of the disease. Left ventricular ejection fraction <50%. Left ventricular walls are thin and areas of dyskinesis may be observed. The left atrium is also dilated. varying degrees of mitral regurgitation
X-ray
This very large heart has a globoid shape because all of the chambers are dilated. It felt very flabby, and the myocardium was poorly contractile
SYMPTOMS
Symptoms often develop gradually and usually include symptoms of right heart failure and/or left heart failure Because the body compensates for dilated cardiomyopathy, the disease may have no symptoms initially. As the condition worsens, the heart may perform normally when a person is resting, but may cause symptoms during periods of exercise or psychological stress
The incidence and prevalence of cardiomyopathy appears to be increasing. The reported incidence is 0.013-0.084% Cardiomyopathy is an important cause of morbidity and mortality among the world's aging population Sex: men/women is 2.5/1 Age: All age groups are affected. However, studies suggest that 50% of patients with new onset of disease are younger than 2 years
symptoms
fatigue shortness of breath on exertion, orthopnea (breathing difficulty when lying down), waking up at night short of breath swelling of the ankles excessive urination at night irregular heartbeat (palpitations--a feeling of racБайду номын сангаасng or skipping of the heart) decreased urine output (may not include at night)
Myocardial biopsy
The number of biopsy specimens collected should be limited to the minimum required (usually 4-8) Myocyte hypertrophy and fibrosis without lymphocytic infiltrate