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扩张型心肌病的病因

Authors
Marilyn Weigner, MD, FACC
James P Morgan, MD, PhD
Section Editor
William J McKenna, MD
Deputy Editor
Susan B Yeon, MD, JD, FACC
Translators
陈少敏, 主治医师

引言

扩张型心肌病(dilated cardiomyopathy, DCM)的特征为一侧或双侧心室扩大及收缩功能减退[1-5]。受累患者的心脏收缩功能减退，可能发生或不发生显性心力衰竭(heart failure, HF)。首发表现可以包括房性和/或室性心律失常，且疾病任何阶段都可以发生猝死。 (参见“心肌病的定义和分类”)

目前在美国，DCM每年大约引起10,000例死亡和46,000例住院。此外，特发性DCM是心脏移植的主要指征[6]。

DCM的定义、临床表现和病因总结在此。疑似心力衰竭患者的初始评估及随后为明确病因进行的评估将单独讨论。 (参见“疑似心力衰竭患者的评估”)

定义

存在左心室或双侧心室扩大及收缩功能减退(如，左心室射血分数<40%或缩短分数<25%)的证据时才能诊断为DCM[1,2]。如果经由病史询问、体格检查、实验室检查、冠状动脉造影(以排除一支或多支冠状动脉阻塞>50%)、超声心动图和心内膜心肌活检(如果有指征)排除了DCM的原发性和继发性病因(如心肌炎和冠状动脉疾病)，则应考虑为特发性DCM。 (参见“心内膜心肌活检”)

临床表现

大多数DCM患者在20-60岁期间发病，但儿童和60岁以上者也可出现DCM[3]。受累患者存在多种临床表现[3,7]。心力衰竭症状(逐渐加重的劳力性呼吸困难、运动耐量下降、端坐呼吸、夜间阵发性呼吸困难和外周水肿)最为常见。其他表现包括偶然发现无症状性心脏扩大及与共存的心律失常相关的症状、传导障碍、血栓栓塞并发症或猝死[7]。 (参见“疑似心力衰竭患者的评估”，关于‘临床表现’一节)

                                

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Literature review current through: 2017-06 . | This topic last updated: 2016-01-05.
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