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1、ViralMyocarditisIntroductionMyocarditis:Myocarditisisdefinedasinflammatorychangesintheheartmuscleandischaracterizedbymyocytenecrosis.Thereareallkindsofcausesandviralinfectionsarethemostcommoncause.EtiologiesandPathogenesyVirusinfection:Themostcommoncausesofmyocarditisarecoxs
2、ackieAandB,echovirus,adenovirusandcytomegalovirus.DirectlydamageAuto-immunoreactionClinicalmanifestationSymptoms:Thepresentationdependsonthepatient’sageandtheacuteorchronicprocess.fatigue,pale,chestmalaise,myalgias,bellyacheetc.Severecase:CHF,severecardiacarrhythmia,cardioge
3、nicshock,suddendeathetc.Signs:tachycardia,cardiacdilatation,heartsoundsmaybemuffledanddistant,gallop,signsofCHFandsignsofcardiogenicshock.Cardiacenzymelevels:CPK,LDH,CK-MB,cTnT、cTnIElectrocardiogram:cardiacarrhythmia—prematurebeat,tachycardia,AVblock,ST-TChestradiography:lar
4、gecardiacsihouette,pulmonaryvenouscongestion,edemaAuxiliaryExaminationAuxiliaryExaminationEchocardiography:cardiomegaly,ventriculardisfunction,heartfunction↓pericardialeffusionect.Virologyexamination:viralisolation,specificantibody,PCRidentificationofaviralinfection,myocardi
5、albiopsyetc.DiagnosisDiagnosismayrequirebloodtests,achestX-ray,electrocardiogramorradionuclideangiocardiogram,and,inrarecases,biopsyofatissuesamplefromtheheartmuscle.DiagnosisClinicalFindings1.heartdisfunction,cardiogenicshockorcardio-cerebralsyndrome2.cardiacdilatation(ches
6、tradiography,echocardiography)3.changeofelectrocardiogram4.CK-MB↑orcTnT(+)、cTnI(+)诊断心电图改变：以R波为主的2个或2个以上主要导联的ST-T改变持续4天以上伴动态变化；窦房、房室传导阻滞，完全右或左束支传导阻滞；成联律、多源、多型、成对或并行早搏；非房室结、房室折返引起的异位心动过速；低电压、异常Q波。DiagnosisPathogenies1.Diagnosisindexes:fromendocardium,myocardialtissue,orpericar
7、dialfluidViralisolationPCRidentificationofaviralinfectionSpecificantibodyDiagnosisPathogenies2.Referenceddiagnosisindexesviralisolationfromstool,bloodetcIgM(+)PCRidentificationofaviralinfectionfrombloodDiagnosisDiagnosisguidelines1.Clinicaldiagnosisofmyocarditis:2clinicalfin
8、dings2.Diagnosisofviralmyocarditis:2clinicalfindings+1pathogeniesofdiagnosi
