1.What is dilated cardiomyopathy?
Dilated cardiomyopathy has a slow onset and can develop at any age, with 30-50 years old being the most common, mainly due to enlargement of the heart and reduced contractile function of the heart, which cannot transport blood to the whole body normally. The main manifestations are chest tightness and shortness of breath, palpitations, weakness, dyspnea, abdominal distention, and edema. Echocardiography shows a significant enlargement of the heart chambers, electrocardiogram shows diverse and variable arrhythmias, ST-T changes, etc.
2.What is the incidence of cardiomyopathy?
In recent years, the prevention and treatment of cardiovascular diseases such as hypertension, coronary artery disease and valvular disease have been paid attention to, but many people do not know that cardiomyopathy is also a serious health hazard. According to some hospitals and local statistics, cardiomyopathy accounts for about 15% of inpatients with cardiovascular disease in China, and the population incidence rate is about 1/10000, which means that there are about 120,000 cardiomyopathy patients in China. The mortality rate of cardiomyopathy is very high, and the mortality rate of dilated cardiomyopathy is as high as 35% in 5 years.
3.What is the classification of dilated cardiomyopathy?
Primary cardiomyopathy (idiopathic dilated cardiomyopathy): relatively common. Ischemic dilated cardiomyopathy: mostly caused by long-term chronic myocardial ischemia or ventricular remodeling after acute infarction. It is most common and has a worse prognosis than non-ischemic cardiomyopathy. Secondary cardiomyopathy Hypertensive (dilated) cardiomyopathy: prognosis is better than others. Valvular (dilated) cardiomyopathy: some improvement may be seen with treatment of the primary disease. Anthracycline cardiomyopathy, perinatal cardiomyopathy, etc.
4.Who should suspect cardiomyopathy?
Patients with family history of dilated cardiomyopathy, history of chronic myocarditis, history of recurrent colds, history of herpes zoster, history of hepatitis B; or history of long-term chronic myocardial ischemia, history of myocardial infarction; or history of long-term hypertension; or history of valvular disease, with four or more symptoms such as chest tightness and shortness of breath, palpitations, fatigue and weakness, cough, edema of both lower limbs, arrhythmia, etc. should be suspected of having dilated cardiomyopathy.
5.What are the characteristics of dilated cardiomyopathy?
Secondary dilated cardiomyopathy, especially post-infarction cardiomyopathy or valvular cardiomyopathy, is easy to detect because of the original disease;
In contrast, hypertensive or primary dilated cardiomyopathy is relatively insidious, and is not easily detected in the early stages because the primary cause is unclear and the symptoms are not obvious, and many patients discover that they may have cardiomyopathy during physical examination. This type of cardiomyopathy can have no special manifestations in the early stage, and special symptoms, such as fatigue, will only appear during physical activity. As the disease progresses, some mild manifestations of heart failure such as cough and chest tightness may appear, and some patients are not easily detected during this period, and many people usually do not go to the clinic. More than 80% of cardiomyopathy patients can be accompanied by arrhythmias, such as premature beats, atrial fibrillation, conduction block, etc. Arrhythmias can lead to sudden death in severe cases, so early detection and early treatment of cardiomyopathy is very important.
6.Is there any relationship between dilated cardiomyopathy and age? Does it occur more often in the elderly?
Generally speaking, older people may have more factors that trigger and aggravate the heart load, so the incidence of secondary cardiomyopathy is higher than that of younger people. However, there is no strong relationship between heart enlargement disease and age, especially primary cardiomyopathy. Some people think they are young and will not get heart disease, in fact, the onset of cardiomyopathy does not distinguish between age and size, but still the majority of young and middle-aged men.
7.Western medical treatment characteristics and problems of dilated cardiomyopathy?
Western medicine treatment of heart failure has developed considerably in recent years, and its advantageous aspects.
(1) Drugs
Cardiac diuretics, vasodilators, B-blockers, angiotensin-converting enzyme inhibitors (ACEI) and angiotensin II receptor antagonists, and other applications.
(2) Heart Failure Pacing Therapy
It is mainly used for severe bradycardia and ventricular electrical activity asynchrony, which can improve cardiac function and reduce mitral regurgitation.
(3) Cardiac surgery treatment
Heart transplantation, cardiomyoplasty, etc.
Nevertheless, the etiology and pathogenesis of primary cardiomyopathy are still poorly understood in Western medicine, and the conventional treatment for patients with mid- to late-stage cardiomyopathy can only relieve symptoms and delay the process of heart failure, and cannot give a satisfactory treatment.
8.What are the characteristics of TCM treatment for cardiomyopathy?
Advantages of TCM treatment.
In recent years, it is gradually recognized that primary cardiomyopathy is closely related to viral infection and immune malfunction. And Chinese medicine has traditionally held certain advantages in the treatment of antiviral and immune regulation.
(1) TCM emphasizes a holistic view, which can improve the quality of survival of patients, effectively reduce symptoms, improve palpitations and weakness, chest tightness, abdominal distension, sweating, insomnia, mental depression, and weakness of the back and knees, and reduce external sensations by improving immunity.
(2) Eliminate the side effects of western medicine.
Such as betalactam dosage adjustment, usually start with small amount. The dosage is incremented once every two weeks, and it takes two months to adjust to the target amount. If the rate of increment is fast, the patient will experience weakness and severe bradycardia, which cannot be tolerated. If the adjustment is slow, the patient’s treatment time is often delayed. Combined Chinese and Western medicine treatment can shorten the dosage adjustment time from once every two weeks to seven days, and in some cases, once every three days in increments, without obvious side effects, which buys time for the patient’s early recovery, stabilization and reduction of sudden death.
(3) No western medicine forbidden area
If heart failure is accompanied by renal insufficiency or hypotension, ACEI drugs are restricted. In heart failure with bronchial asthma or severe intraventricular block, atrioventricular block and severe sinus bradycardia, β-blockers are restricted, and in heart failure with low potassium, digitalis is restricted. Chinese medicine is not obviously prohibited.
(4) Myocardial fibrosis treatment
The chronic heart failure after dilated heart disease is also a serious stage of myocardial fibrosis, whether through effective treatment, to stop its progress or even reverse to a normal state is the key to our treatment of dilated heart disease. Our research project: “Research on anti-myocardial fibrosis in the chronic stage of viral myocarditis” has achieved the expected results, which confirmed that Chinese medicine can intervene in the process of heart failure through anti-myocardial fibrosis, and the research was awarded the first prize of scientific and technological achievements by Henan Provincial Education Department.
9.How to prevent dilated cardiomyopathy?
The cause of primary cardiomyopathy is not very clear, but there are still some susceptibility factors such as patients should prevent infections, including respiratory and intestinal infections. In addition, patients with viral myocarditis that is prolonged can develop into dilated cardiomyopathy, so patients who have had myocarditis in the past should be reviewed regularly for early detection. There is also a relationship between cardiomyopathy and genetic factors, so people with a family history should have regular checkups.
Secondary cardiomyopathy should be prevented by actively preventing and treating the primary cause, reducing the load on the heart by controlling blood pressure, improving myocardial ischemia, replacing valves, and cautiously using drugs with cardiotoxic effects. Cancer patients taking antitumor drugs or some psychiatric patients using some antidepressant drugs can have toxic side effects on the heart muscle when acting on it for a long time. Therefore, patients who take these drugs for a long time should go to the hospital for regular checkups once the corresponding symptoms appear.
10.How to prevent sudden death in cardiomyopathy patients?
Despite the availability of drugs, interventional therapy, surgery and other treatments, cardiomyopathy is still a disease with a high mortality rate, so it is important to diagnose and control the progression of the disease early. Patients, especially teenagers, should see a doctor promptly if they experience bouts of panic, exceptionally fast heartbeat and syncope; family members with a family history of sudden death in the young should be routinely examined. If there is a case of sudden death as a child in this family, then all those who are related by blood should have tests including ECG, echocardiogram, etc., and if necessary, an MRI.
11.How to eat properly for cardiomyopathy patients?
Patients with cardiomyopathy should pay attention to their diet, eat a light diet and forbid to eat greasy food. And try to eat less and more meals, because a full meal is one of the main triggers to increase the burden on the heart. In addition, cardiomyopathy patients, especially in heart failure, must strictly control the intake of salt, if too much salt intake will aggravate the symptoms of swelling.
12, cardiomyopathy patients how to reasonable physical exercise?
Adolescents with cardiomyopathy or congenital heart disease and elderly people with high-risk factors should avoid too strenuous exercise because, in addition to sudden death caused by heart disease, excessive exercise is also an important cause of sudden death. Some experts have counted nearly 400 cases of sudden death from sports abroad, about 90% of the cases of sudden death from sports are related to heart disease.
In terms of physical exercise: during the progression of the disease, resting and avoiding exertion; after the disease is stabilized, aerobic exercise should be chosen as the main, moderate and moderate.