klisemfg Chapter 335 Hate Chapter
Chapter 335 Hate Chapter
(It’s really annoying to meet and greet a bunch of relatives I’m not familiar with. It also wastes my time.)
Viral myocarditis refers to localized or diffuse acute or chronic inflammatory lesions of the myocardium caused by viral infection, which is an infectious myocardial disease. During the viral epidemic infection period, about 5% of patients develop myocarditis, and the disease may also occur sporadically. The clinical manifestations vary in severity. The diagnosis is considered based on the typical history of prodromal infection; corresponding clinical manifestations; electrocardiogram, myocardial injury markers, and evidence of myocardial injury shown by echocardiography, and the diagnosis depends on endomyocardial biopsy. There is currently no specific treatment, and treatment is mainly aimed at viral infection and myocardial inflammation. Most patients recover after appropriate treatment, and very few patients die in the acute phase due to severe arrhythmias, acute heart failure, and cardiogenic shock. Some patients may develop dilated cardiomyopathy.
A variety of viruses can cause myocarditis, among which viruses that cause intestinal and upper respiratory tract infections are the most common. Coxsackie virus group A, coxsackie virus group B, ECHO virus, and polio virus are common viruses that cause myocarditis, among which coxsackie virus group B is the most important virus. Others include adenovirus, influenza, parainfluenza virus, measles virus, mumps virus, Japanese encephalitis virus, hepatitis virus, herpes zoster virus, cytomegalovirus, and HIV.
The clinical manifestations of patients with viral myocarditis depend on the extent and location of the disease. Mild cases may be asymptomatic, while severe cases may cause heart failure, cardiogenic shock and sudden death.
Patients often have a history of upper respiratory tract or intestinal infection 1 to 3 weeks before the onset of the disease, manifested by fever, body aches, sore throat, fatigue, nausea, vomiting, diarrhea and other symptoms, followed by palpitations, chest tightness, chest pain or dull pain in the precordial area, dizziness, dyspnea, edema, and even Adams-Stokes syndrome. Very few patients develop heart failure or cardiogenic shock.
Physical examination may reveal: 1. Enlarged heart: patients with mild illness usually do not have enlarged heart, while patients with severe illness may have mild to moderate enlargement of heart; 2. Changes in heart rate and rhythm: tachycardia that is not parallel to fever, abnormally slow heart rate and various arrhythmias, among which premature ventricular contractions are the most common; 3. Changes in heart sounds: the first heart sound is weakened or split, and the heart sounds may be like fetal heart rhythm; 4. If the pericardium is affected at the same time, pericardial friction sound may be heard; 5. Other signs of combined heart failure: moist rales in the lungs, distended jugular veins, enlarged liver and edema of both lower limbs, etc.; 6. Signs of cardiogenic shock may appear in severe cases.
The clinical diagnosis of viral myocarditis is mainly based on: a history of intestinal infection or respiratory infection before the onset of the disease, clinical manifestations of cardiac damage, positive myocardial injury markers, other auxiliary examinations showing myocardial damage, positive etiological tests, etc. The clinical diagnosis of viral myocarditis should be considered. The diagnosis depends on endomyocardial biopsy.
Most patients with viral myocarditis have a good prognosis if diagnosed and treated early. Very few patients die from severe arrhythmias, heart failure, or cardiogenic shock. Since there is no effective cure for viral infection and individual responsiveness varies, a small number of patients may develop dilated cardiomyopathy. For patients who have developed dilated cardiomyopathy, standardized treatment should be given according to dilated cardiomyopathy.
When considering the diagnosis of viral myocarditis, beta-receptor hyperfunction, hyperthyroidism, mitral valve prolapse syndrome and other diseases that affect the myocardium, such as coronary heart disease, connective tissue disease, metabolic disease, Keshan disease, heart damage caused by drugs and toxins, should be excluded.