廖玉华阜外心肌病诊治进展英文 ppt课件培训讲学.pptVIP

Advancement of diagnosis and therapy in cardiomyopathies 心肌病诊治进展 ;;Dilated Cardiomyopathy;DCM phenotype with genetic occurrenc;DCM phenotype with sporadic occurrence;Criteria ① left ventricular end-diastolic dimension（LVEDd） 2.7cm/m2 ② left ventricular ejection fraction（LVEF）45% and/or factional shortening 25% Exclusion：① hypertension, ② CHD, ③ long-term overdose drinking alcohol, ④ persistence supraventricular arrhythmia, ⑤ systemic disease, ⑥ pericardial disease, ⑦ congenital heart disease, ⑧ pneumocardial disease ;① diagnostic criteria of dilated cardiomyopathy ② The diagnosis of familial dilated cardiomyopathy is made: 1. in the presence of two or more affected individuals in a single family 2. or in the presence of a first-degree relative of a dilated cardiomyopathy patient, with well documented unexplained sudden death at 35 years of age;① diagnostic criteria of dilated cardiomyopathy ② immunologic markers —anti-heart antibodies are main markers1 including: anti-ANT Ab、anti-?1-receptor Ab、anti-MHC Ab、anti-M2-receptor Ab Secondary markers including： persistent viral infection Th2 cell predominance cytokines genetype of humam leucocyte antigen;Analysis of autoantibody in dilated cardiomyopathy;Immunopathogenesis in DCM;Treatment of DCM;1．β-receptor blocker To inhibit the anti-β1-Ab mediated myocardiual damage, especially in early stage Especially suit for the patients with tachycardia or ventricular arrhythmias, or with anti-β1-Ab patients Dose：metroprolol 6.25mg Bid to 12.5～100 mg Bid, slowly titrate ;;2． Diltiazem Frequece of Anti-ANT antibody is positive about 60%-95% Mechanism： Anti-ANT antibody increased Ca current of myocardial cell. Diltiazem could inhibit the antibody mediated myocardial damage and protect myocardium Diltiazem might be used in early stage of DCM Dosage： diltiazem 30 mg tid ;Calcium antagonist clinical trial in DCM;Calcium antagonist clinical trial in DCM;ISDDC trial Prognosis analysis in DCM;;Heart i