Goodwin J F
Hammersmith Hospital, London, England.
Drugs. 1989 Dec;38(6):988-99. doi: 10.2165/00003495-198938060-00009.
The cardiomyopathies are defined and classified into hypertrophic, dilated and restrictive types. In hypertrophic cardiomyopathy the major abnormalities of structure (massive ventricular hypertrophy, myofibrillar disarray, and narrow intramural coronary arteries) and of function (excessive ventricular contraction, systolic pressure gradients, increased ventricular stiffness with impaired relaxation and a tendency for sudden death) are used as the basis for selective and rational treatment with beta-blocking, calcium blocking, or antiarrhythmic agents, or a combination. Treatment is aimed at relieving symptoms, improving prognosis and slowing the progress of disease. Additional methods of treatment involving pacemakers and defibrillators are covered, and the place of septal resection, mitral valve replacement and cardiac transplantation discussed. General management and advice to the patient, and the treatment of complications such as atrial fibrillation, congestive heart failure and infective endocarditis, are also covered. In dilated cardiomyopathy measures to improve ventricular function by vasodilator therapy and the place of antiarrhythmic and anticoagulant drugs are discussed. The controversial treatment with beta-adrenergic blocking agents is reviewed, and the place of immunosuppressive therapy assessed. The possible use of antiviral agents in the future is commented upon, and cardiac transplantation is emphasised as the most effective, although radical, means of improving prognosis in intractable cases. In restrictive cardiomyopathy due to endomyocardial fibrosis, treatment of the initial inflammatory stage with steroids or sulphonylurea, and of the later fibrotic and thrombotic stage with anticoagulants and endocardectomy, is surveyed. The possible place of cardiac transplantation both for endomyocardial fibrosis and amyloid heart disease is mentioned, caution being urged when either of these conditions involves organs other than the heart.
心肌病被定义并分为肥厚型、扩张型和限制型。在肥厚型心肌病中，结构（大量心室肥厚、肌原纤维排列紊乱和壁内冠状动脉狭窄）和功能（过度心室收缩、收缩压梯度、心室僵硬度增加伴舒张功能受损及猝死倾向）的主要异常被用作使用β受体阻滞剂、钙通道阻滞剂或抗心律失常药物或联合用药进行选择性和合理治疗的基础。治疗旨在缓解症状、改善预后并减缓疾病进展。文中涵盖了涉及起搏器和除颤器的其他治疗方法，讨论了室间隔切除术、二尖瓣置换术和心脏移植的地位。还涵盖了对患者的一般管理和建议，以及心房颤动、充血性心力衰竭和感染性心内膜炎等并发症的治疗。在扩张型心肌病中，讨论了通过血管扩张剂治疗改善心室功能的措施以及抗心律失常和抗凝药物的地位。对β肾上腺素能阻滞剂的争议性治疗进行了综述，并评估了免疫抑制治疗的地位。评论了未来可能使用抗病毒药物的情况，并强调心脏移植是改善难治性病例预后的最有效（尽管是根治性）方法。在因心内膜纤维化导致的限制型心肌病中，调查了用类固醇或磺脲类药物治疗初始炎症阶段，以及用抗凝剂和心内膜切除术治疗后期纤维化和血栓形成阶段的情况。提到了心脏移植在心内膜纤维化和淀粉样心脏病中的可能地位，当这些情况中的任何一种累及心脏以外的器官时需谨慎行事。
