Health Worlds

(A) DCM (dilated cardiomyopathy)
The main features of dilated cardiomyopathy systolic pump dysfunction, one or both chambers of the heart to expand, resulting in congestive heart failure. Also known as congestive cardiomyopathy. The disease is often accompanied by arrhythmias.
(1) The cause of idiopathic, hereditary and viral infections, which is the main reason of viral myocarditis.
(2) expansion of the main chambers of the heart pathology, visible ventricular dilation; wall much thinner, the formation of fibrous scar, and often accompanied by mural thrombosis. Valve, coronary artery did not change much. Tissue non-specific cardiac hypertrophy, degeneration, especially in varying degrees of fibrosis, mixed lesion exists a high incidence of male to female.
(3) slow onset of clinical symptoms have shortness of breath, and even orthopnea, edema, and congestive heart failure liver and large signs and symptoms. Embolism can occur in some patients, or sudden death. signs: major signs for the enlargement of the heart, 75% of cases could be heard was the third or fourth heart sound gallop. Often associated with various types of arrhythmia.
(4) The diagnosis and differential diagnosis of the disease lack specific diagnostic criteria, clinical cardiac enlargement seen, arrhythmia and congestive heart failure patients, if confirmed by echocardiography and cardiac determined to expand the diffuse cavity pulse weakened, that is, should consider the possibility of t


his disease, but it should be clear except for a variety of causes of structural heart disease.
(5) the principles of treatment and the prognosis is for treatment of congestive heart failure and various arrhythmias. Physical activity is usually limited, low-salt diet, application of digitalis and diuretics, digitalis should be used with caution but, in order to avoid poisoning.
In digitalis, diuretics, at the same time, the choice of by the off-blockers, calcium channel blockers, vasodilator agents and angiotensin-converting enzyme (ACE) inhibitors, start small dose, depending on the symptoms, signs to adjust the amount of long-term oral administration. For some patients with severe late in the cardiac, diuretic, vasodilators and ACE inhibitors and other drugs on the basis of DDD pacemaker implantation. Should control the virus infection, hypertension, diabetes, alcohol consumption, nutrition disorders, the factors that make the disease worse. Heart transplantation as a method of treatment of severe heart disease by being recognized.
(B) hypertrophic cardiomyopathy (hypertrophic cardiomyopathy)
Hypertrophic cardiomyopathy is a myocardial hypertrophy asymmetric, smaller ventricular chamber is characterized by blocked blood filling the left ventricular diastolic compliance decreased as the basic pathological cardiac disease, divided into hypertrophic obstructive and non-obstructive hypertrophic cardiomyopathy.
(1) causes autosomal dominant genetic disease, sarcomere contractile protein gene mutation is a major factor.
(2) Pathological features of hypertrophic cardiomyopathy is unequal ventricular septal thickening ASH. Cardiac hypertrophy is also uniform / the type of apical hypertrophy. Histological features as cardiac hypertrophy, shape specificity, disordered. Left ventricular septal myocardial cells in particular.
(3) clinical symptoms: some patients may be no symptoms, many patients have palpitations, chest pain, exertional dyspnea. Associated with outflow tract obstruction in patients with dizziness when standing or moving, or even loss of consciousness and so on. signs: physical examination may have slightly increased the heart, to hear the fourth heart sound; outflow tract obstruction who left sternal border 3 4 intercostal injection of a rough systolic murmur, mostly functional murmur, apical Department of systolic murmur often can be heard.
(4) The diagnosis and differential diagnosis of clinical or ECG in patients with coronary heart disease such as younger patients, inadequate basis for the diagnosis of CAD can not be explained by other heart disease, you should think about the possibility of this disease. With ECG, echocardiography and cardiac catheterization to diagnose. If positive family history (sudden death, cardiac enlargement, etc.) is more helpful in the diagnosis.
And hypertensive heart disease, coronary heart disease, congenital cardiovascular disease, such as differentiated from aortic stenosis. By ultrasound, cardiac angiography, myocardial biopsy and other methods.
(5) the principle of relaxation therapy treatment of myocardial hypertrophy, preventing tachycardia and maintain normal sinus rhythm, reducing left ventricular outflow tract obstruction and resistance to ventricular arrhythmias. Advocates of -blockers and calcium channel blockers such as propranolol, nifedipine treatment. Patients with severe obstruction can be used for interventional or surgical treatment plant DDD pacemaker, ablation or the removal of the septal myocardial hypertrophy.
Hypertrophic cardiomyopathy with dilated cardiomyopathy associated with dilated cardiomyopathy during treatment of heart failure treatment.
Guidance on living patients, advise patients to avoid strenuous exercise, prudent, or breath-hold, to reduce the incidence of sudden death. The slow progress of the disease, should be long-term follow-up, and their immediate families ECG, echocardiography and other tests for early detection of HCM patients in the other family.
(C) restrictive cardiomyopathy (restrictive cardiomyo pathy)
Restrictive cardiomyopathy is characterized by obstruction of ventricular diastolic filling. The proliferation of cardiac interstitial fibrosis (EMF) as its main pathological changes, ie endocardial and subendocardial fibrous thickening of a few millimeters, ventricular intimal sclerosis, expansion was limited. Fever, general malaise as the initial symptoms, leukocytosis, especially eosinophils increased more significantly, the disease and into the wall of fibrous endocarditis associated with hypereosinophilic syndrome related. Then gradually palpitations, difficulty breathing, edema, hepatomegaly, neck vein engorgement, ascites, heart failure symptoms. Also known as constrictive endocarditis.
ECG showed sinus tachycardia, atrial hypertrophy, T wave low and flat or inverted.
Poor prognosis of this disease, only symptomatic treatment. Poor response to conventional treatment of heart failure, often become refractory heart failure, embolization, more complications, may consider the use of anticoagulant drugs. In recent years, surgical dissection with intimal thickening of the heart is better, cirrhosis of the liver can be used before the advent of heart transplantation.
(D) of arrhythmogenic right ventricular cardiomyopathy type
1. Pathologic features:
Arrhythmogenic right ventricular cardiomyopathy type is characterized by progressive right ventricular myocardium is replaced by fibrous adipose tissue, initially as a focal, progressive heart showed diffuse involvement.
2. Cause of left ventricular also sometimes involved, and involved relatively few intervals. Often familial disease, the Department of autosomal dominant inheritance.
3. Usually manifested clinical arrhythmia, right heart to expand and sudden death.
4. Arrhythmia treatment should be the control room. Buried high-risk patients with automatic implantable cardiac defibrillator.
(V) unclassified cardiomyopathy
1. Classification unclassified cardiomyopathy is classified as not suitable for these types of cardiac disease (such as elastic fiber hyperplasia, non-dense cardiomyopathy, ventricular dilation is very light and less contraction, mitochondrial involvement).
2. Cause arrhythmias and conduction system disease may be the cause of cardiomyopathy.
Myocarditis (an important test sites)
Myocarditis refers to inflammation of myocardial itself.
(A) cause
Infectious diseases is most important is cardiac viral myocarditis, common virus Coxsackie A, B, ECHO, polio virus, influenza and herpes viruses.
Virus in the way the myocardium: virus directly violated myocardial injury myocardial small blood vessels; immune mechanisms of myocardial injury resulting; toxin myocardial damage.
(B) Pathology
Acute viral myocarditis the histological characteristics, the melting of myocardial cells, interstitial edema, mononuclear cell infiltration
(C) Clinical manifestations and diagnosis
1. Symptoms about half of the 1 to 3 weeks before the onset of a virus infection prodrome so-called "cold" like symptoms or nausea, vomiting and other gastrointestinal symptoms. And palpitations, chest pain, difficulty breathing, swelling or even Adams Stokes syndrome.
2. Visible signs of physical heat level is not parallel with tachycardia, a variety of arrhythmias, third heart sound or noise can be heard. Or jugular vein distention, pulmonary rales, hepatomegaly and signs such as heart failure. Severe cardiogenic shock may occur.
3.EGG visible ST-T changes in ECG, R wave reduction, pathologic Q waves and a variety of arrhythmias, particularly atrioventricular block, ventricular contraction. Echocardiography showed left ventricular wall can diffuse (or limitations) to reduce the contraction amplitude, and so can increase the left ventricle.
4. Laboratory tests serology CK, AST.LDH increased erythrocyte sedimentation rate to accelerate, leukocytosis, C-reactive protein increase and so the diagnosis. Serum virus neutralizing antibodies, hemagglutination inhibition antibody or complement fixation antibody to be measured repeatedly. Repeated endomyocardial biopsy can help diagnose the disease, illness and prognosis. The diagnosis depends on virus infection of myocardial endocardial, myocardial, or pericardial tissue virus, virus antigen detection or virus gene segments.
(D) Treatment
Bed in patients with acute myocarditis and nutritional supplements should be quiet, mainly for the treatment of heart failure, the use of diuretics, vasodilators, angiotensin converting enzyme (ACE) inhibitors. Easily be used with caution due to digitalis poisoning. Complete atrioventricular block may consider the use of temporary pacemaker. Currently do not advocate the early use of corticosteroids, but there is atrioventricular block, heart failure, severe autoimmune patients or consider the case can be used with caution. Too tired or sick enough sleep, death can be short term, it is quiet and bed rest have important therapeutic implications.



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