[SCD-FORUM] 50E 请问Fontaine医师和Hammill医师——Brembilla Perrot医师

[SCD Symposium]

50E 请问Fontaine医师和Hammill医师——Brembilla Perrot医师
尊敬的Dubner医师，Schapachnik医师：
同时我也就一些问题向其他一些医生请教。

有些事情看起来非常简单：没有器质性心脏病的心动 
过速与晕厥通常预后良好，而有心脏疾病的则完全不 
同。然而，随着核磁共振（MRI）或其他类似的技术的 
发展，是否许多患者在心超下没有发现明显的心脏疾 
病表现例如心肌瘢痕引起的室速、致心律失常性右心 
室发育不良引起的右室流出道室速、扩张性心肌病早 
期等，使得原先认为是良性的室性心动过速变得具有 
引起猝死的危险？

是否所有存在室速和晕厥，而心超正常的患者均需行 
MRI检查？

MRI异常的无症状室早患者是否需要进一步的检查，并 
预防性使用beta-受体阻滞剂或其他治疗？

我认为心脏病学变得愈来愈难。过去我们从一个或几 
个作者的小规模研究中了解到心脏病学中许多重要的 
信息，现在我们从一些大公司组织的大规模多中心研 
究获得一些信息，在这些研究中存在着公认的排除与 
入选对象标准。那么我自己的病人在哪儿?

感谢你们对我在实际工作中遇到的问题不吝赐教。

Béatrice Brembilla-Perrot

--
Sergio Dubner医师
科委会主席
Edgardo Schapachnik医师
组委会主席
毛晔译  王玲洁校
50E Questions to Dr. Fontaine and Dr. Hammill. Dr. Brembilla Perrot
Dear Dr Dubner and Dr Schapachnik

I have also questions to some authors as Dr Fontaine and Dr Hammill
Some things seem very simple: tachycardia or syncope is of benign
prognosis if there is no underlying heart disease. The significance
completely changes in association with heart disease.
However with the development of magnetic resonance imaging (MRI) or
similar techniques, many of patients have signs of heart disease not
visible at echocardiography as myocardial scar in VT, signs of ARVD
in right outflow tract tachycardia, signs of beginning DCM..... A
benign VT becomes a tachycardia with a risk of SD??

Is RMI necessary in all patients with VT or syncope and with   
apparently normal echocardiography? Does abnormal RMI in asymptomatic  
patient with only VPB's need others
investigations, preventive beta-blocker therapy or more??

To my opinion, the cardiology becomes more and more difficult. We   
have learned many important data in cardiology through small studies   
of one or several authors; now we learn some data after very large   
multicentric studies engaged by big companies with the very well
known problem of the criteria of exclusion and inclusion. Where is  
my  patient?

Pardon my difficulties in the real life and thank you for your   
recommendation.
Béatrice Brembilla-Perrot

--
Dr. Sergio Dubner
President of Scientific Committee

Dr. Edgardo Schapachnik
President of Steering Committee