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According to different clinical presentations of patients, ischemic cardiomyopathy can be divided into two categories, namel


y, type of ischemic congestive cardiomyopathy and ischemic cardiomyopathy restrictive, is very similar to their clinical performance in primary dilated cardiomyopathy cardiomyopathy and restrictive cardiomyopathy, but, in essence, ischemic cardiomyopathy and idiopathic cardiomyopathy have different.
The performance of ischemic cardiomyopathy patients are different, most patients can occur with congestive cardiomyopathy or restrictive cardiomyopathy performance, while the few patients can no obvious clinical symptoms, following ischemic heart disease according to different types describe the corresponding clinical manifestations.
1. Ischemic cardiomyopathy with congestive type which the performance of congestive cardiomyopathy cardiomyopathy accounted for the vast majority of patients, common in the elderly, mostly male patients, there was a history of coronary heart disease, male: female was about 5 7:1, the symptoms usually occur gradually, were mainly the following aspects, (1) Angina: Angina is one of the main symptoms of patients, but with the emergence of heart failure, angina can be decreased or even disappeared , ischemic heart disease and more clear history of coronary heart disease, and most had more than 1 a history of myocardial infarction, angina pectoris in patients with ischemic cardiomyopathy is a common clinical symptoms, but not angina, myocardial necessary in patients with ischemic symptoms, some patients also showed only silent myocardial ischemia, angina pectoris or myocardial infarction has never been the performance of about 72% to 92% of cases of ischemic heart disease angina occurred attack, it was reported that 1 / 3 to 1 / 2 cases of myocardial infarction was missed, this recurring and regular presence of silent myocardial ischemia or myocardial infarction can gradually lead to congestive type of ischemic heart disease, these patients no angina pain threshold may be higher due to the lack of protective significance of angina pectoris the alarm system, but in such patients, the persistence of silent myocardial ischemia, myocardial damage has continued to exist until the emergence of congestive heart failure model, it was considered that silent myocardial ischemia in the clinical significance and dangers of angina with the same symptoms of myocardial ischemia, angina pectoris in patients with the disease symptoms may progress in the gradual deterioration of congestive heart failure, angina pectoris gradually reduce or even disappear, only showed chest tightness, fatigue, dizziness or difficulty breathing and other symptoms.
(2) Heart Failure: Heart failure is often the development of ischemic cardiomyopathy inevitable to a certain stage of the performance of the early slow progress, the rapid progress in the event of failure, most patients chest pain or myocardial infarction in the early stage of heart failure performance, which is due to acute myocardial ischemia caused by cardiac diastolic and systolic dysfunction caused by the current study shows that transient myocardial ischemia, the main damage of early diastolic function, which is soothing properties; long-term recurrent myocardial ischemia, causing obvious signs of advanced diastolic dysfunction , that is, reduced left ventricular compliance, increased stiffness, large myocardial infarction in the myocardial interstitial networks destroyed, causing acute ventricular dilatation, increased compliance to the heart chamber; and special treatment for myocardial infarction or fibrosis, can be chambers of the heart caused by increased stiffness, decreased compliance, that ventricular dilatation after myocardial infarction, increased compliance, if more myocardial ischemia, left ventricular early diastolic filling can occur obstacles and increase the hardness of the heart chamber, the patient usually presents labor respiratory difficulties, can develop severe orthopnea paroxysmal nocturnal dyspnea and left ventricular dysfunction such as performance, accompanied by fatigue, weakness symptoms, reduced cardiac auscultation the first heart sound can be heard and the middle and late diastolic gallop, both lungs at the end could be heard and scattered in the wet? tone, if the late failure associated with right ventricular function, the patient developed anorexia, peripheral edema and right upper quadrant Fullness flu symptoms, physical examination shows filling or engorgement jugular vein, heart community to expand, liver enlargement, tenderness, and positive signs of liver jugular venous return, which slow the development of peripheral edema, conceal, for the edema that depression often start from the drooping position, and gradually upward.
(3) arrhythmias: long-term, chronic myocardial ischemia leading to myocardial necrosis, myocardial stunning, myocardial hibernation, and until focal or diffuse fibrosis, scar formation, resulting in barriers to cardiac electrical activity, including the impulse formation, distribution and transmission may be an exception, type in the ischemic congestive cardiomyopathy can occur in the course of various types of arrhythmia, especially ventricular contractions, atrial fibrillation and bundle branch block more common, in the same patients with ischemic cardiomyopathy body, the performance of complex arrhythmias, mainly due to: causes of complex arrhythmias, such as myocardial necrosis, fibrosis, myocardial ischemia or other causes of injury; mechanism for the formation of complex arrhythmias, including the exhumation mechanism, self-discipline or triggering mechanism of increased; complex type of arrhythmia, a patient can not only occur with supraventricular and ventricular arrhythmias, conduction block can occur; late arrhythmia type of transient lesion varied, about half of the ischemic myocardial died in a variety of serious arrhythmias.
(4), thrombosis and embolism: cardiac chamber thrombosis and embolism more common in cases: the cardiac chambers were significantly expanded; without anticoagulant treatment of atrial fibrillation; decreased cardiac output who were bedridden without physical activity in patients complicated by deep vein thrombosis, pulmonary embolism after off, has been reported in patients with ischemic cardiomyopathy thrombosis rate of 14% -24%.
Should be noted that although the type of ischemic cardiomyopathy with congestive common clinical manifestations of congestive heart failure, but there are some patients with severe symptoms and left ventricular function and myocardial damage often is not unusual between the proportional change, which may and myocardial infarction the size and scope of the relevant parts of the number, and some patients with myocardial infarction occurred in multiple sites, and distributed in more than two dominant within the coronary artery to a single site in terms of infarction and necrosis of the range may not be great, but myocardial necrosis in several parts of the ventricular function despite the same size than those confined to myocardial necrosis and myocardial damage as a part of those much larger, the other, ischemic heart disease than the average wall thickness Despite repeated myocardial infarction but not ischemic cardiomyopathy with congestive type of person, type of dilated congestive cardiomyopathy or valvular heart disease who are thinner ventricular wall, which may be due to extensive coronary artery disease, severely limits the blood supply, so that can not moderate hypertrophy of myocardial necrosis or myocardial ischemia due to end after the temporary mast complex and atrophy.
2. Restrictive Although the majority of ischemic cardiomyopathy patients with ischemic cardiomyopathy, dilated cardiomyopathy similar performance, but a small number of clinical manifestations in patients with left ventricular diastolic dysfunction mainly based, and myocardial contractile function is normal or only mildly abnormal , similar to restrictive cardiomyopathy symptoms and signs, it is called restrictive cardiomyopathy or ischemic heart syndrome hard (stiff heart syndrome), patients often have exertional dyspnea and (or) angina, thus events limited, these patients are often due to recurrent pulmonary edema and treatment, patients can no history of myocardial infarction, heart often do not expand, left ventricular end diastolic pressure and diastolic volume and ejection fraction increased only slightly reduced, even in the acute myocardial infarction, although some patients had pulmonary congestion or pulmonary edema, it can be nearly normal left ventricular ejection fraction, and fully explain cardiac dysfunction in these patients is mainly diastolic dysfunction, the type of missing congestive cardiomyopathy patients often have abnormal pressure - volume curve in patients with resting left ventricular end diastolic pressure is also higher than normal, when the acute ischemic attack, a further decline of ventricular compliance (ie, stiffness in the heart of further increase) makes the increase in left ventricular end-diastolic pressure to produce pulmonary edema, and systolic function can be normal or only slightly damaged.
Diagnosis of the disease must have 3 positive and 2 negative terms conditions, three conditions must: a clear history of coronary heart disease, at least 1 or more myocardial infarction (with Q wave or non Q wave myocardial infarction); heart expanded significantly; signs of heart failure and (or) laboratory evidence; two negative conditions: exclusion of certain complications such as ventricular septal coronary perforation, heart aneurysm, and papillary muscle dysfunction caused by mitral incomplete, as these complications can also be produced, although the heart to expand and heart failure, but the main reason for these mechanical complications led to the results of cardiac hemodynamic disturbance, although the ejection fraction decreased, but less <0.35 is not the heart of long-term hypoxia, ischemia, and myocardial fibrosis results, it can not be referred to as ischemic cardiomyopathy, the above is a complication of myocardial infarction and coronary heart disease, its treatment of the main measures for the surgical correction, and ischemic cardiomyopathy mainly medical treatment, both very different, other than heart disease or other causes of heart enlargement and heart failure.



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