老年人心肌病与慢性心力衰竭

Cardiomyopathy and chronic heart failure in the elderly

老年人心力衰竭占全部心力衰竭的75%。心肌病是导致老年人心力衰竭和死亡的主要疾病之一。老年患者通常因合并的基础疾病较多,原发性心肌病需与继发性心肌病,尤其是缺血性心肌病进行鉴别。在超过65岁的老年肥厚型心肌病患者中,最主要的死亡原因为心力衰竭、心房颤动导致的卒中和猝死,心力衰竭的年死亡率为5%~6%。大约1/4的心力衰竭由扩张型心肌病引起,放射性核素显像和心导管检查是鉴别扩张型心肌病与缺血性心肌病的重要辅助检查。老年慢性心力衰竭的治疗原则以防治心肌损伤、保护重要脏器灌注和提高生活质量为原则。本文旨在分析心肌病所引起的心力衰竭及其危险分层和治疗策略,以防治心肌损伤,保护重要脏器灌注和提高生活质量。

The percent of elderly patients more than 65 years of age is 75% failure （CHF）. Cardiomyopathy is one of the major causes leading to heart failure and death in the elderly-. Elderly- pa- tients usually suffer from the combination of underlying diseases. Primary cardiomyopathy should be differentiated from the secondaU cardiomyopathy, especially for ischemic cardiomyopathy. Among elderly patients with hypertrophic ear- diomyopathy over 65 years,the most important causes of death include heart failure, stroke and sudden death caused by atrial fibrillation. The annual mortality rate of heart failure is 5% - 6%. About the ratio of 1/4 of heart failure is caused by dilated cardiomyopathy. Radionuclide imaging and cardiac catheterization are both important auxiliary exam- inations for differentiating dilated and ischemie cardiomyopathy. The purpose of this review is to analyzing the risk stratification and treatment strategy- of heart failure associated with cardiomyopathy in order to prevent cardiomyopathy.