《心肌炎》由会员分享，可在线阅读，更多相关《心肌炎（39页珍藏版）》请在金锄头文库上搜索。
1、,MYOCARDITIS,Xiaohong Tang,OUTLINE,Definition,Etiology,Viral Myocarditis,DEFINITION,Myocarditis ： one kind of myocardial diseases. said to be present when the heart isinvolved in an inflammatory process.,The inflammation may involve： myocytes interstitium vascular elements pericardium,DEFINITION,ETI
2、OLOGY,Infectious agents:bacteria （细菌） parasite（寄生虫） spirochaete（螺旋体） fungus （真菌） rickettsial（立次克体）virus （病毒）,Three basic mechanisms: invasion of the myocardium production of a myocardial toxin immunologically mediated myocardial damage,ETIOLOGY, Infectious agents:, Drugs Physical and chemical factor
3、s Allergic reactions Systemic diseases: vasculitis,virus,ETIOLOGY, Etiology,VIRAL MYOCARDITIS, Pathology, Clinical Manifestations, Physical Examination, Lab Findings, Diagnosis, Management,Etiology,VIRAL MYOCARDITIS,Adenovirus Arbovirus Coxsackievirus （柯萨奇病毒） Echovirus Cytomegalovirus Respiratory sy
4、ncytial virus Encephalomyocarditis virus Human immunodeficiency virus,VIRAL MYOCARDITIS,PATHOLOGY,.1,Patients with viral myocarditis demonstratea wide spectrum of gross and histologicalchanges:,VIRAL MYOCARDITIS,PATHOLOGY,.2,Gross: The hearts in acute cases are flabby, with focal hemorrhages. In chr
5、onic cases, the heart is enlarged and hypertrophied.,VIRAL MYOCARDITIS,PATHOLOGY,.3,Histol: The histological hallmark of viralmyocarditis is an inflammatorymyocardial infiltrate, with associatedevidence of myocyte damage.,VIRAL MYOCARDITIS,PATHOLOGY,.4,Histol: The inflammatory infiltrate in viral in
6、fections, lymphocytes are seen in bundance.,CLINICAL MANIFESTATIONS,.1,Depending on: the stage of the disease the mechanism of myocardial damage the specific etiological agent differing genetic susceptibility of patients,CLINICAL MANIFESTATIONS,.2,asymptomatic,symptomatic,CLINICAL MANIFESTATIONS,.3,
7、asymptomatic,complete recovery,unrecognized arrhythmias,dilated cardiomyopathy(DCM),CLINICAL MANIFESTATIONS,.4,symptomatic,complete recovery,acute congestive heart failure,dilated cardiomyopathy(DCM),death,CLINICAL MANIFESTATIONS,.5,symptoms of viral infection,fatigue fever muscle pain,CLINICAL MANI
8、FESTATIONS,.6,symptoms of cardiovascular system,dyspnea palpitations precOrdial discomfort chest pain acute congestive heart failure,.1,PHYSICAL EXAMINATION,Tachycardia is usual and may be out of proportion to the temperature elevation.,.2,PHYSICAL EXAMINATION, The first heart sound is often muffled
9、. The protodiastolic gallop may be present.,.3,PHYSICAL EXAMINATION, A transient apical systolic murmur may appear. But diastolic murmurs are rare.,.4,PHYSICAL EXAMINATION, clinical evidence of congestive heart failure:, the heart size : normal or dilated, pulmonary and systemic emboli :,.1,LAB FIND
10、INGS,Electrocardiograpy:,Abnormalities of the ST segment And T wave,.1,LAB FINDINGS, atrial and ventricular arrhythmias, AV and intraventricular conduction defects, Q waves,Electrocardiograpy:,.2,LAB FINDINGS,Radiological Examination:,normal,enlarged,.2,LAB FINDINGS,Echocardiography:, increased wall
11、 thickness left ventricular thrombi ventricular dysfunction abnormal diastolic filling,.2,LAB FINDINGS, 心肌损伤标志物升高 病毒及病毒抗体,.1,DIAGNOSIS, Clinical Manifestations: Physical Examination: Laboratory Findings:,.2,DIAGNOSIS,诊断依据（一）：病史和体征,病毒感染史 心脏表现 不能用其他原因解释,.2,DIAGNOSIS,诊断依据（二）：心律失常或心电图改变,窦性心动过速、传导阻滞 早搏、心
12、动过速、扑动、颤动 STT改变或Q波,.2,DIAGNOSIS,诊断依据（三）：心肌损伤的参考指标,肌钙蛋白、心肌酶学 超声心动图 核素心功能检查,.2,DIAGNOSIS,诊断依据（四）：病原学依据,病毒、病毒基因片段、病毒蛋白抗原 病毒抗体 病毒特异性IgM,.3,DIAGNOSIS,诊断标准：临床诊断:（一）（二.任何一项）（三.任何二项）病原学诊断：确诊：临床诊断（四、中第1、）拟诊：临床诊断（四、中第2、3、）,.1,MANAGEMENT, bed rest or restricted activity,.2,MANAGEMENT, control congestive heart failure, control significant symptomatic arrhythmias,.3,MANAGEMENT,The use of other drugs:, corticosteroids, nonsteroidal anti-inflammatory agents, gamma globulin, antiviral agents immunosuppressive agents antilymphocyte monoclonal antibodies,Definition,Etiology,Viral Myocarditis,SUMMARY,THANK YOU,
