心肌病心内科文档资料.ppt

《心肌病心内科文档资料.ppt》由会员分享，可在线阅读，更多相关《心肌病心内科文档资料.ppt（25页珍藏版）》请在三一办公上搜索。

1、Case A 36 year old man comes to your office complaining of three months of progressive fatigue and dyspnea on exertion.Several times in the past month he has awakened from sleep with severe breathlessness and felt a need to sit up in order to breath.He denies any chest pain.He has no past medical hi

2、story of heart disease,hypertension or diabetes.His family history is negative for heart disease.He does not smoke and drinks alcohol only rarely.He takes no medications.,Physical Examination,BP 105/70mmHg,P 98 regularLungs:rales.Heart:Enlarged heart border.S1 diminished intensity,S2 normal,S3 is pr

3、esent.2/6 systolic murmur at the apex.Abdomen:Liver is enlarged and slightly tender to pressure.Extremities:Mild edema of both feet.,Dilated Cardiomyopathy,DCM,Definition,Heart muscle disorderEnlarged left ventricle or both ventriclesImpaired systolicpump functionOften with manifestation of heart fa

4、ilure or arrhythmia,Epidemiology,Annual incidence:5-10 patients per millionMale-female ratio:2.5:1Average age of incidence:40Higher incidence in the developing countriesAnnual mortality rate:25%-45%,Etiology,Not clearFamilial/genetic(20%)Viral infectious agents and autoimmuneAcute viralmyocarditis c

5、an progress to chronic dilated cardiomyopathyChronic hormonal disorders Use of certain substances,especially alcohol,cocaine,antidepressants,and chemotherapy drugs,Pathology,Gross examination：Thinned ventricular walls Enlarged ventricles Fibrin and scar Mural thrombus Normal valves and coronary arte

6、ries,DCM Normal,Microscopic examination:Myocardial cell may be hypertrophy,denaturation,fibrosis or necrosis.,Pathology,Pathophysiology,Pump less blood for the bodys needs,Heart failure,Myocardial changes involve conduction system,Arrhythmia,Mural thrombus fall off,Embolism,Clinical Manifestation,Sy

7、mptoms：No symptom in the early stage Fatigue,dyspnea,orthopnea Anorexia,edema Palpitation,arrhythmia(Af,VT)Embolism(brain,lung,lower extremity)Sudden death(VT,embolism,bradycardia),Clinical Manifestation,Signs：Cardiac dullness extends to left and downwards Rales,pleural effusion Jugular venous diste

8、ntion,hepatomegaly,edema Gallop rhythm,S3,S4Systolic murmur over the apex area(mitral insufficiency),Accessory Examination,Chest X-ray Enlargement of the heart Signs of pulmonary congestion,Accessory Examination,ECG Atrial fibrillation Conduction block ST-T changes Low-voltage QRS Pathologic Q wave

9、Ventricular premature or tachycardia,Accessory Examination,Accessory Examination,Echocardiography Dilated left ventricle or both ventricles Relative mitral/tricuspid insufficiency due to dilated left/right ventricle Ventricular walls not thick Poorly contractile left ventricle EF 50%,Accessory Exami

10、nation,Coronary angiography:Usually normalCardiac biopsy:Fibrosis or myocardial celluar hypertrophy,denaturation or necrosis,Exclude other heart diseases,Dilated heartArrhythmiaHeart failure,Echo:dilated&poorly contractile ventricle,Coronary/Rheu-matic/Hypertensive heart disease,Diagnosis,Specific c

11、ardiomyopathy,EXCLUDE,Diagnosis,DCM,Ischemic cardiomyopathy ICM,Age,History,Often in middleage，40 years old,Often in old age，40 years old,Myocarditis,No history of angina,Risk factors of CHD,history of angina or myocardial infarction,Differential diagnosis,DCM,ICM,Echo,Often four chambers dilated，th

12、e weak movement of whole heart,mural thrombus in some patients,Often only left ventricle dilated,segmental movement abnormality，ventricular aneurysm in some patients,Angio-graphy,Normal,Multivessel disease,Differential diagnosis,Treatment,General treatmentDecreased activity and bed restSalt restrict

13、ionStop alcoholNutritional support,Treatment,Treatment of heart failureDigitalisDiureticsVasodilatorsACEI(angiotensin converting enzyme inhibitors)ARB(angiotensinreceptor blockers),Treatment,Antiarrhythmic treatmentBeta blockers(start with low-dose,increase dose gradually)Amiodarone Pacemaker implantationICD(implantable cardioverter defibrillator),Treatment,CRT(Cardiac Resynchronization Therapy)Surgery:heart transplantation,Questions,What are echocardiographic findings in DCM?How to distinguish between DCM and ICM?How to treat DCM?,