- Dilated cardiomyopathy
(1) Treatment principles
1) Maintain normal rest, use sedatives if necessary, low salt diet in case of heart failure.
2) Prevent arrhythmia and cardiac insufficiency.
3) Anticoagulation therapy for patients with a history of embolism.
4) If there is a large amount of pleural effusion, perform pleural puncture.
5) For severe patients, artificial heart assistance devices or heart transplantation can be considered, and cardiac resynchronization therapy can be performed.
6) Symptomatic and supportive treatment.
(2) Treatment of heart failure
1) Rest and avoid fatigue must be emphasized, and those with enlarged heart and decreased heart function should pay attention to long-term rest to avoid deterioration of the condition.
2) Cardiotonic drugs, diuretics and vasodilators are used in patients with heart failure. Because of extensive myocardial damage, digitalis and diuretics are beneficial. Hydrochlorothiazide may be ineffective at low glomerular filtration. In this case, loop diuretics such as furosemide are required. Vasodilators, such as angiotensin-converting enzyme inhibitors. It is necessary to start with a small dose and pay attention to avoid hypotension. β-blockers may improve prognosis when heart failure is stable.
3) Patients with arrhythmia, especially those with symptoms, should be treated with antiarrhythmic drugs or electrical methods, and patients with rapid ventricular rhythm and high atrioventricular block and risk of sudden death should be actively treated.
4) Oral anticoagulants or antiplatelet aggregants can be used to prevent embolic complications.
5) For long-term heart failure, patients who have failed medical treatment should consider heart transplantation, actively control infection after surgery, improve immune suppression, correct rejection, and the survival rate after 1 year can reach more than 85%.
(3) Medication precautions
1) When cardiomyopathy changes, it is sensitive to digitalis drugs, and the application dose should be small, and pay attention to toxic reactions, or use non-cardioside positive inotropic drugs.
2) Electrolyte balance must be paid attention to during the application of diuretics.
3) When using drugs that inhibit heart rate or electrocardiotactic tachyarrhythmia, one should be alert to the possibility of concurrent sinus syndrome.
4) Permanent artificial pacemaker can be installed in patients with chronic complete atrioventricular block and sick sinus syndrome.
5) During the application of antiarrhythmic drugs, the ECG should be reviewed regularly.
6) During the use of anticoagulants, attention should be paid to bleeding manifestations, and regular review of clotting time, prothrombin time and INR.
(4) Special treatment
Heart transplantation for dilated cardiomyopathy can prolong life, and the prognosis is greatly improved after heart transplantation.
