Leachman R D
Department of Adult Cardiology, Texas Heart Institute, Houston 77030, USA.
Tex Heart Inst J. 1995;22(2):126-33.
In sum, systolic dysfunction of the ventricle associated with left ventricular outlet obstruction and often with mitral valve regurgitation may be improved by myotomy, myomectomy, mitral valve replacement, and perhaps by the creation of left bundle branch block via DDD right ventricular pacing. Diastolic dysfunction of the ventricle may be improved by prolonging the diastolic filling period, shortening the isovolumic relaxation period with calcium channel blocking drugs, or perhaps by altering the atrioventricular activation time with a DDD pacemaker. The symptoms and complications of associated arrhythmias may be improved by medication, particularly with beta-blockers, which tend to stabilize the atrial rhythm and perhaps the ventricular rhythms. In treating patients with demonstrated ventricular arrhythmias, other antiarrhythmic agents may be helpful. (Table II summarizes the abnormalities, causes, and treatments of hypertrophic obstructive cardiomyopathy.) Epicardial coronary atherosclerosis is not rare in these patients, and arteriographic confirmation may lead to improvement by surgical bypass treatment. Since stroke volume is nearly fixed, cardiac output depends very much on heart rate. For this reason, each patient needs to receive the appropriate dosage of medications to achieve the optimal heart rate for his or her own physiologic state.
总之，与左心室流出道梗阻相关且常伴有二尖瓣反流的心室收缩功能障碍，可通过肌切开术、肌瘤切除术、二尖瓣置换术，或许还可通过DDD右心室起搏制造左束支传导阻滞来改善。心室舒张功能障碍可通过延长舒张充盈期、用钙通道阻滞剂缩短等容舒张期，或者或许通过用DDD起搏器改变房室激活时间来改善。相关心律失常的症状和并发症可通过药物治疗改善，尤其是β受体阻滞剂，其往往能稳定心房节律，或许还能稳定心室节律。在治疗已证实有心室心律失常的患者时，其他抗心律失常药物可能会有帮助。（表二总结了肥厚性梗阻性心肌病的异常情况、病因和治疗方法。）这些患者中心外膜冠状动脉粥样硬化并不罕见，血管造影证实后通过手术搭桥治疗可能会有所改善。由于每搏输出量几乎固定，心输出量在很大程度上取决于心率。因此，每个患者都需要接受适当剂量的药物治疗，以达到适合其自身生理状态的最佳心率。
