分类： yutyiyu

▼ The author of this article ▼

Hypertrophic cardiomyopathy (HCM) is a myocardial disease with unknown causes, characterized by asymmetric myocardial hypertrophy, which usually means that the thickness of ventricular septum or left ventricular wall measured by echocardiography is ≥15mm, or the thickness of patients with a clear family history is ≥13mm, the ventricular cavity becomes smaller, the left ventricular blood filling is blocked, and the left ventricular diastolic compliance decreases. It is necessary to exclude the thickening of left ventricular wall caused by increased load such as hypertension, aortic stenosis and congenital aortic subvalvular diaphragm.

How to diagnose hypertrophic cardiomyopathy?

01exertional dyspnea

The most common symptom, about 90% or more will show this symptom.

02chest pain

Many patients will show fatigue chest pain, or atypical pain may continue to occur at rest or after meals, but coronary angiography is normal.

03Syncope or threatened syncope

About 15%-25% of patients have had at least one syncope or threatened syncope, which is usually seen during activity.

04Other symptoms

Dizziness, fatigue, palpitation, etc., some patients are at high risk of sudden death, and some patients have symptoms of heart failure in the late stage.

05pathological/bodily sign

Patients with no or mild obstruction often have no obvious signs, but patients with left ventricular outflow tract obstruction often have heart murmurs, especially after the first heart sound, which are obviously increasing and decreasing, especially between the apex of the heart and the left edge of the sternum.

Some tests are needed to assist the diagnosis in clinic.

01x-ray examination

X-ray examination has no obvious characteristics. The size of the heart may be normal, or the left atrium and left ventricle may be enlarged. The size of the heart is directly proportional to the pressure gradient between the heart and the outflow tract of the left ventricle. The greater the pressure gradient, the larger the heart. Aorta does not widen, pulmonary artery segment does not protrude obviously, pulmonary congestion is mostly light, and right ventricular enlargement may occur in the late stage.

02electrocardiogram

Because of cardiac ischemia, abnormal myocardial repolarization, left ventricular or biventricular hypertrophy and ST-T changes are common, atrioventricular block and left bundle branch block are also common, and sometimes deep and inverted T wave or abnormal Q wave can be seen, this disease often has various types of arrhythmia.

03ultrasonic cardiogram

It is of great significance for the diagnosis of HCM. The main performances are:

① Abnormal thickening of ventricular septum, and the thickness of ventricular septum at the end of diastole is > 15 mm..

② The motion amplitude of interventricular septum decreased obviously, generally ≤ 5 mm..

③ The ratio of ventricular septal thickness to left ventricular posterior wall thickness can reach 1.5-2.5:1, and it is generally considered that the ratio > 1.5: 1 has diagnostic significance.

④ The left ventricular end systolic diameter is smaller than normal, and the blood flow velocity of left ventricular outflow tract is accelerated.

⑤ The distance between the interventricular septum and the anterior leaflet of mitral valve is often significantly reduced at the start of contraction.

⑥ The systolic phase of the anterior leaflet of mitral valve moves forward, approaches the interventricular septum, and ends before the second heart sound.

⑦ Aorta closed in the middle systole.

04dynamic electrocardiogram

All patients have perfect 24-hour ECG monitoring, in order to evaluate whether there is ventricular arrhythmia and judge the cause of palpitation or syncope.

05Cardiac magnetic resonance

High sensitivity, but high cost. Myocardial fibrosis can also be found.

06Coronary angiography

Coronary angiography should be evaluated if the patient has angina pectoris or persistent ventricular arrhythmia.

07Cardiac catheterization

Left ventricular outflow tract obstruction is suspected, but the clinical manifestations and imaging examination are different; It needs to be differentiated from constrictive pericarditis; Preoperative evaluation of heart transplant patients.

08Gene detection

Most patients often have a family history and have genetic mutations.

Complications of hypertrophic cardiomyopathy

01arrhythmia

Ventricular arrhythmia and atrial fibrillation are common, and in severe cases, there are ventricular tachycardia, ventricular fibrillation and cardiac arrest, which can cause sudden cardiac death in severe cases.

02arterial embolism

The common site is the left atrial appendage, and it can also form thrombus in the left ventricle, which can cause arterial embolism after the thrombus falls off.

03cardiac failure

Due to myocardial hypertrophy, the compliance of ventricular relaxation is reduced, which can cause left ventricular diastolic dysfunction and increase left ventricular end diastolic pressure and left atrial pressure in the early stage. With the progress of the disease, it may be accompanied by left ventricular dilatation and contraction dysfunction, resulting in severe heart failure symptoms.

Image source of this article: Photo Network

Author’s introduction

Xu Hui

Xuzhou Central Hospital

Attending physician of cardiology department

Introduction:Master’s degree, graduated from the Department of Cardiology, Yangzhou University, worked in the 3A hospital for several years, and mastered the diagnosis and treatment of various common diseases in cardiology, such as coronary heart disease, hypertension, arrhythmia, valvular disease, heart failure and other diseases.

CCTV News:According to the "Shaoxing CDC News" in WeChat official account, the monitoring data of Shaoxing CDC show that since November, the percentage of influenza-like cases in outpatient and emergency treatment in Shaoxing has shown an obvious upward trend, suggesting that Shaoxing has entered the influenza high season, and kindergartens, schools and other crowd gathering places are prone to outbreaks, which should be paid special attention to. It is suggested that kindergartens, schools and other collective places do the following:

1, do a good job in the morning (noon) check-up and registration of absence due to illness. Students with fever, cough and other flu-like symptoms found in kindergartens and schools should inform their parents in time to avoid going to school, and classes can only be resumed 48 hours after the students’ body temperature returns to normal and other flu-like symptoms disappear. For students who are definitely diagnosed with influenza, kindergartens and schools should do a good job in checking the certificate of resumption of classes. At the same time, the school should reasonably arrange the remedial work for students who are absent due to illness, and eliminate the concerns of students and parents.

2, do a good job of daily cleaning and disinfection. Nursery institutions and schools should use wet mops to mop the floor every day, and often carry out preventive disinfection on classroom door handles, tables and chairs, stair handrails, etc. Regularly clean the air conditioning and central air conditioning ventilation system. If there are sick students staying in the classroom, use chlorine-containing disinfectant (such as 84 disinfectant) to wipe the desks and chairs of the sick students, rinse the rag with running water, and soak it in disinfectant for 30 minutes before reuse.

3. Keep the classroom air circulating. Kindergartens and schools should open windows for ventilation at least twice a day for 10-15 minutes each time, and the ventilation time can be selected during the next class, lunch break and after school. Due to the low temperature in winter, pay attention to ventilation to avoid students catching cold.

4. If a teacher has the flu or flu-like symptoms, be sure to arrange for the teacher to rest in isolation at home and not to take classes with illness. Because of the wide range of teachers’ activities, it is easy to cause an outbreak of influenza.

5. Kindergartens and schools should provide running water, hand sanitizer and other necessary hand washing facilities, educate students to wash their hands frequently and develop good hygiene habits. When coughing or sneezing, cover your mouth and nose with paper towels and elbows, wash your hands after coughing or sneezing, and try to avoid touching your mouth, nose or eyes with your hands.

6. Vaccination against influenza is an effective measure to prevent influenza. It is recommended that school teachers and students be vaccinated against influenza every year.

7. When kindergartens and schools have a cluster epidemic of influenza-like cases, they should promptly report to the disease control institutions in their respective jurisdictions. After receiving the report, the disease control institutions should promptly assist kindergartens and schools in their respective jurisdictions to carry out on-site investigation and disposal, and take measures to suspend classes when necessary.

8, nurseries and schools in the high season of influenza epidemic, try to reduce the gathering activities.

9. During the flu season, students should try not to go to crowded public places and try to avoid contact with patients with flu-like cases. Wear a mask when you have symptoms such as fever and cough, or when you are in contact with others. In severe cases, seek medical advice in time, and do not attend class with illness.

　　At present, with the continuous winter in various places, respiratory diseases have entered a period of high incidence. National Health Commission held a press conference on 26th to introduce the prevention and treatment of respiratory diseases in winter in China and answer reporters’ questions.

　　01

　　Recently, acute respiratory diseases have continued to rise.

　　Related to the superposition of multiple respiratory pathogens.

　　At the press conference, Mi Feng, a spokesperson for National Health Commission, said that monitoring showed that influenza was the main infectious disease of respiratory tract recently, and rhinovirus, mycoplasma pneumoniae, respiratory syncytial virus and adenovirus were also caused. It is believed that the recent increase of acute respiratory diseases in China is related to the superposition of various respiratory pathogens.

　　1. All localities should scientifically co-ordinate medical resources, implement a graded diagnosis and treatment system, adjust their strength across disciplines and hospitals, give play to the role of medical associations, and improve the diagnosis and treatment ability of general infections and the efficiency of severe identification and referral;

　　2. Efforts should be made to increase the number of related consulting rooms and treatment areas, appropriately extend service hours, strengthen drug supply security, give play to the role of traditional Chinese medicine, and maximize the ability to receive consultations and the standardization of diagnosis and treatment;

　　3. It is necessary to disclose and continuously update the information of medical institutions that provide services such as pediatrics and fever clinics to the society in a timely manner, and give play to the role of Internet hospitals and primary health care institutions to facilitate the people to seek medical treatment in an orderly manner nearby;

　　4. Do a good job in epidemic prevention and control in schools, kindergartens, nursing homes and other key crowded places, and reduce personnel flow and visits.

　　National Health Commission reminded the public that it is necessary to adhere to the sanitary habits of wearing masks, ventilation and washing hands frequently, and advocate key groups such as "one old and one small" to actively vaccinate relevant vaccines; When you have respiratory symptoms, you should be well protected, keep a social distance, and avoid cross-infection in your family and unit.

　　At present, the health departments of all provinces in China have published the information of local medical institutions that can provide pediatric diagnosis and treatment services on the official website and government WeChat platform, and will update them in time.

　　02

　　Recent respiratory infectious diseases

　　Different age groups have different main pathogens.

　　Wang Huaqing, chief expert of immunization program of China CDC, introduced at the press conference that according to the results of multi-pathogen monitoring, the main pathogens prevalent in different age groups of respiratory infectious diseases in recent years are different:

　　Influenza virus and rhinovirus are the main types of people aged 1~4;

　　Influenza virus, mycoplasma pneumoniae and adenovirus are the main population aged 5~14.

　　Influenza virus, rhinovirus and Covid-19 are the main types of people aged 15-59.

　　People aged 60 and above are mainly influenza virus, human metapneumovirus and common coronavirus.

　　03

　　Vaccination for respiratory diseases in the elderly

　　What are the precautions?

　　Vaccination against influenza is an effective means to prevent influenza, which can reduce the risk of influenza and serious complications. The old people were vaccinated with influenza, pneumococcus and other respiratory diseases, and the results showed that it was safe and effective. In the process of inoculation, attention should be paid to:

　　1. Those who have a clear history of severe allergy to vaccines to be vaccinated or to be vaccinated, or vaccines with similar technical routes, cannot be vaccinated again;

　　2. If you have a chronic disease and are in an acute episode, you need to slow down the inoculation and consider vaccination after your health is stable;

　　3. Vaccination doctors should strictly implement the vaccination work norms. If there is any health damage or other reaction suspected to be related to vaccination after vaccination, they should seek medical advice in time and report.

　　04

　　Children have fever and cough.

　　There are no signs of aggravation, so you don’t have to go to the hospital repeatedly.

　　The child has a respiratory disease, and the main symptoms are fever and cough.

　　Wang Quan, chief physician of Beijing Children’s Hospital, National Children’s Medical Center, said in an interview with CCTV reporter that fever and cough are almost inevitable after respiratory infection. As long as there are no signs of aggravation in this process, there is no need to go to the hospital repeatedly.

　　"The purpose of taking antipyretics is not to lower the body temperature to normal, but to increase the comfort of children and let them spend the fever period safely and comfortably. All diseases have a recovery process, especially for diseases with respiratory virus infection, which usually takes 3 to 5 days to recover. "

　　In addition, Wang Quan said that parents are usually not advised to give their children antitussive drugs by themselves. Cough is a protective reflex of the human body. It is good for children to relieve their illness by coughing it out because of throat discomfort or secretions in the respiratory tract. If cough seriously affects children’s sleep, parents can relieve it by atomization under the guidance of a doctor.

　　05

　　How to prevent respiratory diseases in winter?

　　In winter, respiratory infectious diseases enter the season of high incidence. Influenza, adenovirus, respiratory syncytial virus, mycoplasma pneumoniae … What are the symptoms of different respiratory diseases? How to judge which pathogen is infected? How to prevent it? What kind of situation requires immediate medical attention? Poke the map to understand, collect and spare ↓↓↓↓

　　06

　　Drinking Radix Isatidis to prevent colds from hurting the body.

　　Afraid of catching a cold, can you drink Radix Isatidis to prevent it?

　　The answer is: no!

　　In the absence of disease symptoms, if Radix Isatidis is taken as a preventive medicine for a long time and in large doses, it may make our gastrointestinal function disorder and increase the metabolic burden of liver and kidney.