病毒性心肌炎2.ppt

病 毒 性 心 肌 炎Viral myocarditis,VMC Outline Viral myocarditis results due to the viral invasion of the myocardium Etiology viral infection Enterobacteria、RSV RNA viruses especiallyCVB1-6 and A1-9。 RNA Virus DNA Virus The virus to cause human myocarditis Mechanism viral infection Immune system cell damage myocardial Ag exposed, surface Ag changed Natural killer cell infiltration inflamatory necrosis of myocardial cells，lymphocytes infiltration Pathology Myocardial cell lysis Interstitial edema Inflammatory cell infiltration Hemodynamic changes Inflammation of the heart Cardiac enlargement Renal blood flow Blood volum EDV LA pressure PV extravasated blood Right heart extravasated blood Hepatomegaly+ subcutaneous edema CHF stimulation of SNS Afterload Preload Prodrome： viral enteritis symptom： light moderate severe Physical Examination： range form light to severe Clinical Manifestation symptom Fatigue CHF Limitation of activity Arrhythmia Palpitations Cardiogenic shock Chest pain Sudden death light severe Clinical Manifestation PE Shortness of breath cyanosis Low heart sound , Gallop Lung auscultation Hepatospleno- megaly Clinical Manifestation Clinical classification 1.slight 2.moderate 3.Severe Investigations X-Ray: Enlarged heart shadow， ingcreased lung markings Normal X-Ray ECG， Ambulatory electrocardiogram ST-T?changes Investigations Atrial premature beats Ventricular premature beats Paroxysmal Supraventricular Tachycardia Atrial Fibrillation Ventricular Tachycardia Atrioventricular block III° II°II Ventricular pulse weakened LV enlargement Investigations -ECHO Heart ECT Perfusion defect of the Left ventricular posterior wall and lateral wall Investigations myocardial blood biochemical indexes CKand LDH Increase in the early stage is signific