1、2020年10月2日1Viral Myocarditis 第一课件网站 2020年10月2日2IntroductionMyocarditis: Myocarditis is defined as inflammatory changes in the heart muscle and is characterized by myocyte necrosis .There are all kinds of causes and viral infections are the most common cause.2020年10月2日3Etiologies and PathogenesyVirus
2、 infection: The most common causes of myocarditis are coxsackie A and B, echovirus,adenovirus and cytomegalovirus.Directly damageAuto-immunoreaction2020年10月2日4Clinical manifestationSymptoms: The presentation depends on the patients age and the acute or chronic process . fatigue, pale, chest malaise,
3、 myalgias, bellyache etc. Severe case: CHF, severe cardiac arrhythmia, cardiogenic shock, sudden death etc.Signs: tachycardia, cardiac dilatation, heart sounds may be muffled and distant, gallop, signs of CHF and signs of cardiogenic shock. 2020年10月2日5 Cardiac enzyme levels: CPK, LDH, CK-MB, cTnT、cT
4、nI Electrocardiogram: cardiac arrhythmiapremature beat, tachycardia, AV block, ST-T Chest radiography: large cardiac sihouette, pulmonary venous congestion, edemaAuxiliary Examination2020年10月2日6Auxiliary ExaminationEchocardiography: cardiomegaly, ventricular disfunction, heart function pericardial e
5、ffusion ect. Virology examination: viral isolation, specific antibody, PCR identification of a viral infection, myocardial biopsy etc.2020年10月2日7Diagnosis Diagnosis may require blood tests, a chest X-ray, electrocardiogram or radionuclide angiocardiogram, and, in rare cases, biopsy of a tissue sampl
6、e from the heart muscle. 2020年10月2日8DiagnosisClinical Findings 1. heart disfunction, cardiogenic shock or cardio-cerebral syndrome 2.cardiac dilatation ( chest radiography, echocardiography ) 3. change of electrocardiogram 4. CK-MBor cTnT(+)、cTnI(+)2020年10月2日9诊断诊断心电图改变：以心电图改变：以R波为主的波为主的2个或个或2个以上个以上主
7、要导联的主要导联的ST-T改变持续改变持续4天以上伴动态天以上伴动态变化；窦房、房室传导阻滞，完全右或变化；窦房、房室传导阻滞，完全右或左束支传导阻滞；成联律、多源、多型、左束支传导阻滞；成联律、多源、多型、成对或并行早搏；非房室结、房室折返成对或并行早搏；非房室结、房室折返引起的异位心动过速；低电压、异常引起的异位心动过速；低电压、异常Q波。波。 2020年10月2日10DiagnosisPathogenies1. Diagnosis indexes: from endocardium, myocardial tissue, or pericardial fluid Viral isolat
8、ion PCR identification of a viral infection Specific antibody第一课件网站 2020年10月2日11DiagnosisPathogenies2. Referenced diagnosis indexes viral isolation from stool, blood etc IgM(+) PCR identification of a viral infection from blood 2020年10月2日12DiagnosisDiagnosis guidelines1. Clinical diagnosis of myocar
9、ditis: 2 clinical findings2. Diagnosis of viral myocarditis: 2 clinical findings + 1 pathogenies of diagnosis indexes3. Clinical diagnosis of viral myocarditis: 2 clinical findings + 1 pathogenies of referenced diagnosis indexes2020年10月2日13DiagnosisExclusion: rheumatism myocarditis toxic myocarditis
10、 congenital heart diseases cardiomyopathy endocardial fibroelastosis congenital AV block etc.2020年10月2日14Stages Acute phase: 1y2020年10月2日15 TreatmentRest: 3-4w, HD or HF 3-6m.Protect cardiac muscleAntioxidant: VitC, CoQ10, VitEAntivirusCorticosteroids and immunosuppressionOthers16演讲完毕，谢谢观看！Thank you for reading! In order to facilitate learning and use, the content of this document can be modified, adjusted and printed at will after downloading. Welcome to download!汇报人：XXX 汇报日期：20XX年10月10日
