【英文】Osmosis ·【翻译】牛伟伟 ·【校对】ivlvn
Cardiomyopathy译为心肌病， 这是个广义的术语， 用于描述各种因心肌疾病导致的问题。
Cardiomyopathy translates to “heart muscle disease,” so cardiomyopathy is a broad term used to describe a variety of issues that result from disease of the myocardium, or heart muscle.
当心肌病作为某些潜在疾病的代偿方式进展时， 比如说高血压或者瓣膜病，称作继发性心肌病， 但是当其完全自行发展时，称为原发性心肌病。
When cardiomyopathy develops as a way to compensate for some other underlying disease like hypertension or valve diseases, it’s called secondary cardiomyopathy, but when it develops all by itself, it’s called a primary cardiomyopathy.
扩张型心肌病
现在最常见的类型是扩张型心肌病， 扩张型心肌病会导致心脏的四个腔室扩张，或者说变大。
Now the most common type is dilated cardiomyopathy which can cause all four chambers of the heart to dilate, or get bigger.
具体来说，新的房室壁肌节或者肌单位相串联， 随着心腔增大，房室壁就会相对变薄， 与较大的腔室尺寸相比，用于收缩的肌肉较少。
Specifically new sarcomeres or muscle units in the walls are added in series and the chambers grow larger, which leaves the walls relatively thin compared to the large chamber size with less muscle to use for contraction.
换言之，心肌收缩力减退，意味着一次收缩的射血量较前减少了， 意味着每搏输出量减少， 而且倘若心脏逐渐丧失 将血液由左心室泵出体外，由右心室泵入肺部的能力， 患者将会发生双心室充血性心力衰竭， 因为收缩发生于收缩期，我们便说这是一种收缩性心力衰竭。
In other words, they have really weak contractions, which means less blood’s pumped out each contraction, meaning there’s a lower stroke volume, and if the heart’s failing to pump out as much blood to both the body from the left ventricle, and the lungs from the right ventricle, patients develop biventricular congestive heart failure, and since contraction happens during systole, we say this is a type of systolic heart failure.
当心腔增大时，瓣膜容易受到牵拉，瓣膜分隔心房和心室，当受到牵拉时，瓣膜不能完全闭合，导致血液反流入心房，左侧称为二尖瓣反流，右侧称为三尖瓣反流，前者听诊为全收缩期杂音， 意味着它发生于整个收缩期。
Also, when the chambers get larger, they tend to stretch out the valves that separate the atria and ventricles. When stretched, the valves can’t close all the way, so they start to regurgitate blood back into the atria, called mitral valve regurgitation on the left side and tricuspid valve regurgitation on the right —the former of which might be heard on auscultation as a holosystolic murmur, meaning that it happens throughout systole.
另外，你可能在听诊时闻及第三心音， 这是血液涌入并在舒张期撞击扩张心室壁的结果。
In addition to that, you might also hear an S3 heart sound on auscultation which is the result of blood rushing into and slamming into the dilated ventricular wall during diastole.
心律失常是并发症之一，因为牵拉肌壁会刺激一些细胞， 这些细胞位于肌壁内的传导系统中。 有时X线片对于诊断扩张型心肌病很有利。
Arrhythmias can also be a complication, because stretching out the muscle walls can irritate the cells in the conduction system which are within those walls. Sometimes an x-ray can be helpful for a diagnosing dilated cardiomyopathy.
病因
至于原因，大多数时候，原发性扩张型心肌病是特发性的， 也就是说没有明确的病因。 有些病例虽然可以追溯到特定的基因突变 或是像Duchenne肌营养不良症和血色素沉着症之类的遗传病 在某些情况下，它也可能由感染引起， 如会导致心肌炎的柯萨奇病毒B型， 或是锥虫病，一种原虫感染。
As far as causes go, most of the time, primary dilated cardiomyopathy is idiopathic, meaning there isn’t a clearly identifiable cause. Some cases, though can be traced back to specific genetic mutations or genetic conditions like Duchenne Muscular Dystrophy and hemochromatosis. Also in some cases it could be caused by an infection like coxsackievirus B which causes myocarditis, inflammation of the heart muscle, or Chagas disease, a protozoal infection.
酗酒也与扩张性心肌病有密切的联系，因为酒精及其代谢产物对心肌有直接毒性作用。
Also, alcohol abuse is strongly linked to dilated cardiomyopathy, since alcohol and its metabolites have a direct toxic effect on the myocardium.
同样，某些药物也可能是一种病因，包括化疗药物， 像阿霉素和柔红霉素，还有可卡因这样的药物。 另外，湿性脚气病（因缺乏维生素B1/硫胺素），也可导致扩张性心肌病。
Similarly, certain drugs can also be a cause, including chemotherapy drugs like doxorubicin and daunorubicin, but also drugs like cocaine. Also, wet beriberi, having too little Vitamin B1 (aka thiamine), can lead to dilated cardiomyopathy.
围产期心肌病也是一个重要病因， 扩张型心肌病可以发生在妊娠的末三个月， 或发生在分娩后的几周内，可能与妊娠相关高血压有关， 尽管大约一半的患者可在孕后康复。
Peripartum cardiomyopathy is an important cause as well, where dilated cardiomyopathy can develop in the third trimester of pregnancy or in the weeks following delivery, probably because of issues like pregnancy-associated hypertension, although about half of patients recover following pregnancy.
正如你所看到的，很多因素均可导致扩张型心肌病， 并且无论原因如何，结果都是导致心脏收缩功能减退。
As you can see - there are a lot of things that can lead to dilated cardiomyopathy - and regardless of the cause, the outcome is less effective systolic function.
严重扩张型心肌病的治疗包括左心室辅助装置， 或LVAD，这是一种帮助心脏泵血的机械泵，
Treatment for severe dilated cardiomyopathy can include a left ventricular assist device or an LVAD, which is a mechanical pump that assists the heart in distributing blood,
在个别极端情况下可能需要行心脏移植手术。
and in extreme cases someone might have a heart transplant.
Meducal！看到LVAD，有没有想起《实习医生格雷》里
Izzie切断了未婚夫Denny Dequette的LVAD～～
OK！本期医理闪充结束啦～
听说给小星星、小钢镚、小花瓣、大拇指的都是学仙～
未注明出处转载的伙伴小心小黑屋惹～
Likey Likey
Mua！！胸腔积液们下期再见～～