Most patients should undergo comprehensive evaluation of myocardial function and coronary anatomy.

　　大多数病人应该进行全面的心肌功能评价和冠状动脉解剖。

 

　　Echocardiography is useful for excluding hypertrophic cardiomyopathy and valvular heart disease;

　　超声心动图对肥厚性心肌病和瓣膜性心脏病在内的疾病很有用；

 

　　magnetic resonance imaging, for diagnosing arrhythmogenic right ventricular dysplasia;

　　磁共振对有心律失常性右室发育不良症的诊断很有用；

 

　　and myocardial biopsy, for identifying infiltrative diseases such as myocarditis, amyloidosis, hemochromatosis, and sarcoidosis.

　　心肌活检对浸润性疾病如心肌炎、淀粉样变、结节病很有用。

 

　　Coronary angiography shoule be performed to assess for the presence of coronary occlusive disease and to exclude coronary artery anomalies.

　　应该进行冠状动脉血管造影评估冠脉阻塞性疾病的存在和排除冠脉的结构异常。

 

　　Myocardial perfusion scintigraphy provides complementary data for assessing ischemic burden.

　　心肌灌注闪烁照相术对缺血程度估计提供辅助资料。

 

　　Left ventricular function can be assessed by contrast ventriculography, radionuclide ventriculography, or echocardiography.

　　通过对比心室造影、同位素心室造影或超声心动图可以评价左心室。

 

　　Evaluation of SCD survivors also includes Holter monitoring and/or electrophysiologic testing.

　　心源性猝死生还者的评价也包括动态心电图监护仪和/或电生理测试。

 

　　The Electrophysiological Study Versus Electrocardiographic Monitoring (ESVEM) trial showed, however, a 50% 2-year recurrence of ventricular tachyarrhythmias in patients in whom antiarrhythnmic drugs successfully suppressed PVCs.

 

　　The Electrophysiological Study Versus Electrocardiographic Monitoring (ESVEM) trial showed, however, a 50% 2-year recurrence of ventricular tachyarrhythmias in patients in whom antiarrhythnmic drugs successfully suppressed PVCs.

　　但是，电生理研究加心电图监测的试验显示，用药物成功控制的室性早搏病人2年内50%复发

 

　　These data suggest a dissociation between PVC suppression and recurrence of VT; PVCs may represent a marker of left ventricular dysfunction rather than a trigger of SCD, or the arrhythmogenic substrate may change over time.

　　这些资料提示室性早搏的控制和室性心动过速的复发是不相关的；室早可能是代表左室功能紊乱的一个信号，而不是心源性猝死的触发者，或心律不齐的基础可能因时间而变化。

 

　　In SCD survivors, sustained monomorphic ventricular tachycardia is inducible by electrophysiologic testing in 40 to 50% and polymorphic VT in 10 to 20%; in 30 to 50%,no sustained arryhthmia is induced.

　　在心源性猝死生还者中， 40~50%电生理试验能诱导持续单一型室性心动过速，10~20%能诱导多型的，30~50%不能诱导持续的节律异常。

 

　　In patients with ischemic heart disease and left ventricular dysfunction, inducibility of sustained VT carries a poor prognosis.

　　在缺血性心脏病和左室功能不全病人中，能诱导持续室性心动过速预后不良。

 

　　A low ejection fraction is associated with a poor prognosis, however, regardless of whether sustained VT is inducible; patients with an ejection fraction of 30% or less and who are noninducible have a 25% arrythmia recurrence rate at 1 year, whereas noninducible patients with an ejection fraction greater than 30 have a 10 to 15% recurrence rate.

　　但是，不良预后与低射血分数有关，不管持续室性心动过速是否能诱导，射血分数30%以下和不能诱导者1年有25%心律失常复发率，而射血分数大于30%的不能诱导者只有10~15%复发率。

 

　　In patients with SCD and idiopathic dilated cardiomyopathy, sustained monomorphic VT is rarely induced.

　　idiopathic    先天的、初发的、突发的

　　心源性猝死和先天性扩张性心肌病病人中，持续单一型室性心动过速极少能诱导。

 

　　Neither the inability to induce VT nor the ability of drugs to suppress inducible polymorphic VT or VF is a predictor of a favorable outcome.

　　不能诱导室性心动过速不是，用药物能控制的可诱导多型的VT和VF也不是良好结果的信号。

 

　　Chapter 22    Shortness of Breath

 

　　Because of the high prevalence of heart disease and heart failure in the general population, many patients with dyspnea have cardiac abnormalities.

　　由于心脏疾病和心衰的高发，很多呼吸困难的病人有心功能的异常。

 

　　The basis of the dyspnea is usually a high filling pressure of the left ventricle, which cuases high left atrial pressures and high pulmonary capillary and pulmonary arterial pressures, which in turn increase the pulmonary blood volume and reduce lung compliance.