Sami M H
Département de médecine, Royal Victoria Hospital, université Mc Gill, Montréal, Canada.
Arch Mal Coeur Vaiss. 1990 Dec;83 Spec No 4:59-62.
Left ventricular hypertrophy is a problem in itself in patients with hypertension. Hypertensives with left ventricular hypertrophy have a higher incidence of ventricular arrhythmias and sudden death. This article reviews the epidemiological evidence in favour of this association. Although the mechanism of ventricular arrhythmias in patients with left ventricular hypertrophy in unclear, several hypotheses have been suggested including cellular electrophysiological changes, alterations of the myocardial tissue and silent myocardial ischemia. The management of ventricular arrhythmias in hypertensive patients implies an effort to prevent left ventricular hypertrophy by early and aggressive treatment and a judicious choice of antihypertensive agents capable of reducing left ventricular hypertrophy. It is also important to avoid hypokalemia and other electrolytic disorders. Antiarrhythmic drugs should be reserved for symptomatic patients who do not respond to other preventive measures.
左心室肥厚本身就是高血压患者面临的一个问题。患有左心室肥厚的高血压患者发生室性心律失常和猝死的几率更高。本文回顾了支持这种关联的流行病学证据。虽然左心室肥厚患者发生室性心律失常的机制尚不清楚，但已经提出了几种假说，包括细胞电生理变化、心肌组织改变和无症状性心肌缺血。高血压患者室性心律失常的管理意味着要通过早期积极治疗努力预防左心室肥厚，并明智地选择能够减轻左心室肥厚的抗高血压药物。避免低钾血症和其他电解质紊乱也很重要。抗心律失常药物应仅用于对其他预防措施无反应的有症状患者。
