Lyme Carditis
Introduction
Lyme carditis introduction Lymedisease (Lymedisease) is a natural epidemic sputum infectious disease caused by Borrelia burgdorferi infection. The heart disease caused by the disease is called Lyme carditis, which is a serious complication of Lyme disease. one. basic knowledge Sickness ratio: 0.0001% Susceptible people: no special people Mode of infection: non-infectious Complications: arrhythmia atrioventricular block cardiomyopathy
Cause
Lyme cardiomyopathy
Causes:
The pathogen of Lyme disease is a new species of Borrelia, called Borrelia burgdorferi, which is called Borrelia burgdorferi. The pathogen of Lyme disease is only a species of Borrelia burgdorferi, which is more resistant to humidity and low temperature. Strong, but it can be inactivated by heat, dryness and general disinfectants.
Pathogenesis
LD is a systemic, immune-mediated multi-organ inflammatory disease transmitted by Borrelia burgdorfer. The pathogenic spirochet spreads into the organs in the early stage of infection, directly affects the invasion of the spiral and blood, joint fluid and cerebrospinal fluid. The antigen-antibody complex damage, pituitary gland, prostaglandin, interleukin-1 (IL-1) activity and other factors have induced the multi-system inflammation of the human body. Recent studies have also found that dogs or flies can also be carried. Borrelia burgdorfer and bite infection.
Prevention
Lyme carditis prevention
1. The key to prevention is to prevent individual cockroaches and environmental cockroaches during the popular season, and completely remove the weeds and fallen leaves on the roadsides of the forests, resulting in an environment that is unfavorable for breeding.
2. Those who enter the mountain must wear a pest control cap, wear protective clothing and high-sleeve rubber shoes, and spray or rub the repellent on the bare part of the body. If it is found that there is a cockroach into the skin, do not yank it, use oil or ether to drip. Into the body, make it suffocate and gently pull out.
3. If there is ring erythema after biting, you should seek medical advice promptly. Early treatment can prevent late symptoms.
LD is a natural epidemic of infectious diseases that is second only to AIDS. At present, countries around the world are taking active and effective prevention measures and making breakthroughs. It is expected to be greatly improved in the near future.
Complication
Lyme carditis complications Complications, arrhythmia, atrioventricular block, cardiomyopathy
Myocardial damage caused by this disease is generally mild, and is mostly self-limiting.
Arrhythmia
There may be tachycardia, first or second degree atrioventricular block, severe cases may have complete conduction block, a few people may have atrial fibrillation, generally lasting 3 to 6 weeks to fully recover, ECG can appear ST segment Pressure, T wave is low or inverted.
2. Heart failure
Severe cardiomyopathy damage can cause heart enlargement, and symptoms and signs of heart failure occur in the late stage.
Symptom
Lyme heart inflammation symptoms common symptoms local migratory erythema pericarditis sinus blockade block heart failure arrhythmia lung vocal heart enlargement gallop heart sound dyspnea
Clinical manifestation
(1) systemic manifestations: the incubation period of this disease is 3 to 32 days, with an average of 9 days. According to the course of the disease, Lyme disease can be divided into early infection and late infection. Early infection includes first-stage local migratory erythema and second-stage whole body. Disseminated infections and intermittent symptoms in weeks or months are mainly manifestations of early nervous system and heart damage; late infection is a three-stage persistent infection, mainly arthritis, chronic atrophic dermatitis and advanced nervous system Performance, etc., the clinical manifestations of this disease are complex and diverse, can only appear one period, or two periods overlap, can also be a typical three periods.
(2) Carditis performance: the incidence of carditis is less than 10%, mainly as follows:
1 acute carditis: visible heart enlargement, myocardial pericarditis, etc., physical examination can be heard and pericardial friction sound, with mitral regurgitation can be heard in the apex of the apex and systolic hairy murmur, heart failure can have difficulty breathing, rushing Ma Lu and lung voices.
2 arrhythmia: the prominent clinical manifestations of this disease, the disease can involve the sinus node, the atrioventricular junction, the Pu's system, and even the entire conduction system, clinically, the most common atrioventricular block, a few can be expressed as a bundle Branch conduction block, even sinus conduction block can occur, cardiac electrophysiological examination shows that conduction block occurs more than the His bundle, often temporary and reversible, and its recovery is mostly progressive improvement, such as conduction resistance The lag is gradually recovered within 1 to 2 weeks, and a few can be extended to weeks or months.
3 ECG: ST segment depression, T wave low or inverted, conduction block and various arrhythmia.
2. Clinical staging
Clinical stage and main performance of Lyme disease: divided into 3 stages according to its course and clinical manifestations:
Stage I: In the acute phase or early infection, the patient suffers from the bite of the skin for several days or weeks after being bitten, and the transitional erythema gradually increases with the prolongation of the disease course, and disappears within 3 to 4 weeks, often accompanied by fever. Headache, myalgia and other "flu"-like symptoms, local lymph nodes can be swollen and painful.
Stage II: intermediate stage or infection and dissemination period, which can occur 4 to 9 weeks after infection, showing multiple systemic damage, including migratory arthritis, myocarditis and heart involvement.
Stage III: chronic phase or late infection, also known as persistent infection. It enters this phase from a few months to one year after onset. It is characterized by persistent arthritis and neurological disorders, and various central and peripheral nervous systems can occur. Complications.
Examine
Lyme carditis examination
1. General project
White blood cell count increased, nuclear left shift; erythrocyte sedimentation rate increased; serum IgM increased; myocardial enzyme spectrum, troponin and other myocardial damage indicators increased.
2. Helical detection
The spirochetes can grow slowly in the medium. The whole blood, cerebrospinal fluid and the skin of the transitional erythema in the first and second stage patients can be positive after inoculation. The suspicious specimen can be found in the dark field and the spiral can be found. The biopsy specimens were stained with silver or retort, and spirals were also seen.
3. Serological examination
The detection of specific IgM and IgG in blood or cerebrospinal fluid has important diagnostic value. The increase in antibody titer of double sample is 4 times, or the single sample IgM or IgG titer 1:128, all suggest this disease.
4. Animal vaccination
The liver, spleen and kidney suspension of suspected infected animals were inoculated into the abdominal cavity of mice, and if they were able to isolate the spirochetes, they were positive and could be diagnosed.
5. ECG
ST segment depression, T wave low or inversion, conduction block and various arrhythmias may occur.
Diagnosis
Diagnosis and diagnosis of Lyme carditis
Diagnostic criteria
The diagnosis of this disease is generally not difficult, such as in the epidemic areas, multiple seasons, have been bitten, have migratory erythema and abnormal cardiac manifestations, serum-specific IgM and IgG increased, support the diagnosis of this disease, clinical need to identify Mainly due to other reasons, heart block and ST-T changes.
Differential diagnosis
The disease should be differentiated from rheumatic fever, rheumatoid disease, rat bite fever, viral myocarditis, etc. Serological tests are helpful in differential diagnosis.
Rheumatic fever
The disease has fever, erythema, arthritis and heart involvement, etc., based on serum hemolytic streptococcus antibodies, including anti-streptolysin "O", anti-streptokinase, anti-hyaluronidase and anti-M globulin antibodies Such as increased, C-reactive protein positive and pathogen examination can help identify.
2. Rheumatoid arthritis
The disease is a chronic autoimmune disease with symmetrical polyarthritis. It starts from the facet joint and later involves the large joint. The serum rheumatoid factor and anti-rheumatoid arthritis synergistic antigen antibody (anti-RANA antibody) are positive. The joint cavity puncture fluid Find rheumatoid cells and X-ray examination, etc., generally can be identified.
3. Rat bite heat
The disease is caused by small snail and A. faecalis. It has fever, rash, migratory joint pain, myocarditis and central nervous system symptoms. It is easily confused with Lyme disease, according to typical EM, serology and etiology. Check and so on for identification.
4. Viral myocarditis
The disease manifested in the upper respiratory tract infection, diarrhea and other viral infections within 3 weeks of cardiac manifestations, and severe fatigue, chest tightness, dizziness (caused by decreased blood output), apical first heart sounds significantly weakened, diastolic galloping , pericardial friction, heart enlargement, congestive heart failure or A-S syndrome, in the acute phase can detect viruses, viral gene fragments or viral protein antigens from the endocardium, myocardium, pericardium or pericardial puncture Help identification.
