心肌综合症怎样治疗

心肌综合症如何治疗配图，仅供参考

Treatment
# Restriction of physical activity
In suspected or histologically validated myocarditis,restriction of physical activity for at least 6 months is part of the international guidelines. This is highly recommended until the inflammation has disappeared—evidenced by cardiac MRI or endomyocardial biopsy—and cardiac function has normalized.
# Heart failure therapy for inflammatory cardiomyopathy
Heart failure therapy is part of the treatment of inflammatory cardiomyopathy. It was successfully demonstrated in many heart failure trials on angiotensin-converting enzyme (ACE) inhibition such as the CONSENSUS trial with enalapril,the SOLVD trial with captopril,the ATLAS trial with lisinopril,or the HOPE trial with ramipril. In the CHARM and ELITE II trials,angiotensin receptor blockers demonstrated a similar benefit. Today,beta-blockade is part of the therapeutic armamentarium in the treatment of any form of heart failure as demonstrated in the MERIT-HF trial for metoprolol,the CIBIS trial for bisoprolol,and the COPERNICUS trial for carvedilol. In acute cardiac decompensation,loop diuretics are effective and aldosterone receptor blockers should be given on top of the other heart failure drugs as demonstrated by the RALES trials for spironolactone in heart failure and by the EPHESUS trial for eplerenone in heart failure patients after myocardial infarction. According to the findings of the SHIFT trial,ivabradine can be given to treat sinus tachycardia and to reduce heart rate to below 70 bpm. Cardiac glycosides were tested in the DIG trial,which demonstrated a reduction of all-cause and heart failure-related hospitalization with no change in mortality rate. Their use in patients with tachyarrhythmia reduces heart rate and improves the quality of life.
Antiphlogistic treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or indomethacin should be reserved for patients with pericardial involvement,since in murine coxsackie B3 myocarditis this treatment was shown to be detrimental . For treatment of peri(myo)carditis,we prefer colchicine instead,not only in recurrent forms but also for the first attack .
# Antiarrhythmic treatment
Apart from beta-blockers,antiarrhythmic treatments for heart failure and for cardiomyopathy patients have been disappointing. A meta-analysis of all trials with amiodarone demonstrated a reduction in total mortality of 13%,but the SCD-HeFT trial,in which patients with a single-chamber implantable cardioverter-defibrillator (ICD) were randomized to amiodarone or to placebo,showed a decrease in mortality for the treatment group only . The discussion of whether rate or rhythm control is more beneficial in the treatment of atrial fibrillation is still ongoing. Sufficient anticoagulation is important under all circumstances.
# Device therapy
In patients with dilated cardiomyopathy with or without inflammation,antibradycardia pacing in second- and third-degree atrioventricular block or in bradyarrhythmia is well established. If the ejection fraction (EF) is below 35% and acute myocarditis is diagnosed,cause-specific treatment should be carried out with a LifeVest wearable defibrillator. If inflammation has disappeared and cardiac function remains low (EF