心肌病-教学课件.ppt

Epsilon wave εwave Evaluation Echocardiography RV dilatation, regional wall motion abnormalities Radionuclide ventriculography (MUGA) Cardiac MRI Can detect fatty infiltration of RV myocardium Concerns over interobserver variability RV angiography Hypertrophic trabeculae separated by deep fissures RV volume increased Evaluation (continued) Electroanatomic mapping Signal averaged ECG Isoproterenol infusion Myocardial biopsy Ideal method of diagnosis Sensitivity low (< 20% - 67%) due to segmental nature of disease Diagnostic Criteria In 1994, scoring system based on major and minor criteria was introduced Structural changes Histologic tissue changes ECG changes Arrythmias Family History Treatment Major goal is suppression of ventricular tachyarrhythmias (beta blockers) Avoid competitive sports Antiarryhthmic medications (sotalol is usually first line agent) Radiofrequency ablation ICD placement class I recommendation for secondary prevention, class II a for primary prevention Myocarditis Myocarditis Inflammation of myocardium Can be result of systemic disorder or infectious agent Viral-Coxsackie B, echovirus, influenza, parainfluenza, Epstein-Bar, and HIV Bacterial-C. Diptheria, N. meningitidis, M. pneumonia, and beta-hemolytic strep Frequently accompanied with pericarditis MyocarditisClinical Feature Fever, tachycardia out of proportion to fever, myalgias, headache,rigors Chest pain due to coexisting pericarditis Pericardial friction rub Severe cases may have CHF symptoms MyocarditisDiagnosis and Differential ECG-nonspecific changes, AV block, prolonged QRS duration, or ST elevation (with pericarditis) Chest XR-Normal Cardiac Enzymes- may be elevated Differentail-ischemia or infarct, valvular disease, and sepsis Treatment Rest Treat as CHF Immunosuppressive therapy (steroids and azathioprine) may be considered if RV biopsy shows active inflammation, but long-term efficacy has not been demonstrated. ECG：V1导联主波向上，提示应该在左室 * * Figure 1. Free Wall of the Right Ventr