Viralmyocarditis(上课）.ppt

Myocarditis Definition Any inflammation or degeneration of the myocardium outline infectious :virus, bacteria, spirochetes, protozoa non-infectious :immune-mediated diseases, or physical and chemical factors such as drug-induced myocarditis. Etiology 1.The most common Coxsackie B group A group of 2-5 and 9 virus. 2. 1,3,5-9,11-14,16,17 followed by the Eco-virus, and adenovirus type 19-22,25,29,31,33. 3. Influenza virus, rubella virus, polio virus, mumps virus, herpes virus, measles virus, parainfluenza virus, cytomegalovirus, etc.. pathogenesy 1. A direct role in the virus 2. T lymphocyte-mediated immune mechanism Manifestation Most cases of acute myocarditis are clinically silent 60% of pts had antecedent flulike symptoms Large number identified by heart failure and shock symptoms 35% of pts with myocarditis and HF have chest pain May mimic an acute MI with ventricular dysfunction, ischemic chest pain, ECG evidence of injury or Q waves Manifestation May present with syncope, palpitation with AV block or ventricular arrhythmia May cause sudden death myocarditis found at autopsy in 20% of Air Force recruits with sudden death* Manifestation newborns and infants may be associated with poor eating, vomiting, fatigue, occasional shock. Examination ECG : sinus tachycardia is most common diffuse ST-T wave changes myocardial infarction pattern conduction delay and LBBB in 20% complete heart block causing Stokes-Adams attacks ,but rarely require a permanent pacer supraventricular and ventricular arrhythmias Examination Laboratory tests : 1. CK, CK-MB, cTnI and cTnT elevation 2. Viral test Blood studies Sed rate elevation 60% White count elevation 25% CK-MB elevation 12% cTnI 和 cTnT elevation 53% A 4 fold rise in IgG titer over a 4-6 wk per