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yxfbbiedtj · Wysłany: Pon 4:24, 07 Mar 2011

Basic cure severe acute myocarditis in 1 case

Key words] Myocarditis; enlarged heart [CLC] 543.1 [literature flag code] D [Article ID] 1001-1439 (2006) 08-0496-01 patients, female, 13 years old. Due to repeated colds, cough 1 month, can not supine 3d at January 9, 2004 admission. 1 month before admission in children with recurrent colds, sore throat, cough,[link widoczny dla zalogowanych], cough had stopped using anti-inflammatory drugs, 3d before admission, increased cough, sputum white foam slightly, breathing difficulties can not be supine, previously healthy. Admission examination: T35.6 ℃, P140 times / min, R22 times / min, BP95/55mmHg (1mmHg a 0.133kPa), pale, jugular vein engorgement, and a small amount of dry lungs smell, moist 哕 tone, heart border Expanding the left, heart rate 140 beats / min, law Qi, diastolic gallop, the apex grade Ⅱ systolic murmur hair samples. Hepatomegaly, ribs 3.0cm, lower extremity edema. ECG revealed sinus tachycardia, left ventricular high voltage, industrial, Ⅱ, 111, aVL, aVF, V ~ lead ST segment depression 0.05 ~ 0.1mV, T wave low and flat; heart X ray showed bilateral lung congestion, cardiothoracic ratio, 0.55; Echocardiography left atrial 41mm, left ventricular end diastolic diameter of 61mm, left ventricular ejection fraction of 25, moderate mitral regurgitation. Holter showed occasional atrial and ventricular premature beat. Routine blood test showed: WBC6.5 × 10 / L, L56.3. Myocardial enzymes: creatine kinase 230U / L, creatine kinase 28U / L, aspartate aminotransferase 49U / L, lactate dehydrogenase 314U / L, hydroxybutyrate dehydrogenase 317U / L. Coxsackie B group virus IgM (a), anti-Admission diagnosis: acute severe myocarditis, cardiac function Ⅳ. Give oxygen, bed rest, B-blockers, angiotensin converting enzyme inhibitor, diuretic, and vasodilator treatment of cardiac and give anti-virus, vitamin C, vitamin B, 1,[link widoczny dla zalogowanych],6 diphosphate or two, creatine phosphate, astragalus, Shenmai comprehensive treatment, his condition significantly improved the Department of Internal Medicine, Foshan Science and Technology (Foshan, Guangdong, 528000) Foshan First People's Hospital Surgery. Mudanjiang Cardiovascular Hospital, Institute of Cardiology. Regular follow-up after discharge, continue to take vitamin C, vitamin B, coenzyme Q10, metoprolol, captopril, digoxin, diuretics, intermittent service,[link widoczny dla zalogowanych], intravenous fructose 1,[link widoczny dla zalogowanych],6 disphosphate, astragalus, Shenmai etc. . 1 year after discharge follow-up, no patients complained of discomfort, normal school, several review myocardial enzymes, anti-myocardial antibodies, Coxsackie B group virus IgM were all normal. Recently, echocardiography: left atrial 36mm, left ventricular end diastolic diameter 49mm, left ventricular ejection fraction 56. Discussion of the incidence of viral myocarditis upward trend in recent years, but most clinical manifestations of light l, the prognosis is good. A small number of outbreaks of severe acute myocarditis can be, of which 95 patients with a clear history of infection, l clinical manifestations of severe arrhythmia, cardiac enlargement, acute left ventricular failure, cardiogenic shock, and even sudden death. Some patients, especially those who persistently positive anti-myocardial antibodies, easily converted to dilated cardiomyopathy. . The cases of repeated respiratory tract infection, cardiac enlargement, l clinical manifestations of acute heart failure, consistent with the diagnostic criteria for severe acute myocarditis. The anti-heart failure,[link widoczny dla zalogowanych], anti-virus, immune function, supplemented by Astragalus, Shenmai, large doses of vitamin C and 1,6 - diphosphate, achieving a better effect. Regular treatment of patients after discharge to prevent a cold, proper rest, a longer period of application of B-blockers and angiotensin converting enzyme inhibitor treatment of this disease are also important factors for success.