肥厚性心肌病的必威体育精装版指南.pptVIP

Pharmacologic Management Nifedipine or other dihydropyridine calcium channel-blocking drugs are potentially harmful for treatment of symptoms (angina or dyspnea) in patients with HCM who have resting or provocable LVOT obstruction. 对有静息或可激发的LVOT梗阻的HCM患者，用硝苯地平或其它二氢吡啶类钙通道阻滞剂治疗（心绞痛或呼吸困难）症状潜在危害。 Verapamil is potentially harmful in patients with obstructive HCM in the setting of systemic hypotension or severe dyspnea at rest. 对有低血压或严重静息呼吸困难的梗阻性HCM患者，维拉帕米有潜在的危害。 Digitalis is potentially harmful in the treatment of dyspnea in patients with HCM and in the absence of AF. 对没有心房颤动的HCM患者，用洋地黄治疗呼吸困难可能有害。 I IIa IIb III I IIa IIb III I IIa IIb III Harm Harm Harm Pharmacologic Management The use of disopyramide alone without beta blockers or verapamil is potentially harmful in the treatment of symptoms (angina or dyspnea) in patients with HCM with AF because disopyramide may enhance atrioventricular conduction and increase the ventricular rate during episodes of AF. 对有心房颤动的HCM患者，单用丙吡胺而不联合β阻滞剂或维拉帕米治疗（心绞痛或呼吸困难）症状可能有害，因为丙吡胺可增强房室传导，并增加房颤发作时的心室率。 Dopamine, dobutamine, norepinephrine, and other intravenous positive inotropic drugs are potentially harmful for the treatment of acute hypotension in patients with obstructive HCM. 对有梗阻性HCM的患者，用多巴胺、多巴酚丁胺、去甲肾上腺素和其它静脉内用的正性肌力药治疗急性低血压可能是有害的。 I IIa IIb III I IIa IIb III Harm Harm Invasive Therapies Septal reduction therapy should be performed only by experienced operators* in the context of a comprehensive HCM clinical program and only for the treatment of eligible patients with severe drug-refractory symptoms and LVOT obstruction.? 在综合分析HCM临床方案的情况下，只对有严重耐药症状和LVOT梗阻、适合的患者进行治疗，仅由有经验的操作者*来做室间隔减容治疗。 *Experienced operators are defined as an individual operator with a cumulative case volume of at least 20 procedures or an individual operator who is working in a dedicated HCM program with a cumulative total of at least 50 procedures (Section ) *有经验的操作者的定义是：累计开展20次以上手术的医生，或正在致力于HCM方案的工作且该项目将累计开展超过50次以上手术的医生。 I IIa IIb III Management of HCM ?Eli