rheumatic myocarditis
Introduction
Introduction to rheumatic myocarditis Rheumatic myocarditis (rheumaticmyocarditis) mainly involves myocardial interstitial connective tissue. The connective tissue near the myocardial arterioles undergoes fibrinoid necrosis, which in turn forms the Aschoff body. The small body is diffuse or limited in distribution, varying in size and mostly fusiform, most commonly in the posterior wall of the left ventricle, ventricular septum, left atrium and left atrial appendage. In the later stage, the small body undergoes fibrosis and forms a fusiform small scar. Sometimes in children, exudative lesions are particularly obvious, myocardial interstitial edema and diffuse inflammatory cell infiltration. Severe cases often cause heart failure. basic knowledge The proportion of illness: 0.03% Susceptible people: no specific people Mode of infection: non-infectious Complications: acute cardiac insufficiency Chronic cardiac insufficiency
Cause
Causes of rheumatic myocarditis
The causes can be divided into the following categories:
Infectious factors: viruses such as Coxsackie virus, Echo virus, influenza virus, adenovirus, hepatitis virus, etc.; bacteria such as diphtheria, streptococcus, etc.; fungi; rickettsia; spirochetes; protozoa. Among them, viral myocarditis is the most common, and myocardial localized or diffuse acute or chronic inflammatory lesions caused by viral infection are infectious myocardial diseases.
Autoimmune disease: refers to a disease caused by the body's immune response to its own antigen causing damage to its own tissues. For example, systemic lupus erythematosus and giant cell myocarditis, most of the reasons are unknown, may be related to genetics, infection, drugs and the environment.
Physical factors: myocardial damage caused by radiotherapy of the chest.
Chemical factors: such as a variety of drugs such as some antibiotics, tumor chemotherapy drugs.
Prevention
Rheumatic myocarditis prevention
Strengthen physical exercise, improve the body's ability to resist disease, pay attention to rest after the onset, enter a nutritious diet, in order to facilitate the recovery of the heart.
Complication
Rheumatic myocarditis complications Complications acute cardiac insufficiency chronic cardiac insufficiency
Arrhythmia, acute heart failure and cardiogenic shock and death, some patients after a few weeks or months after the disease is stable, but there is a certain degree of heart enlargement.
Symptom
Rheumatic myocarditis symptoms common symptoms palpitations, chest tightness, hernia, chest tightness
Rheumatic myocarditis can often affect myocardial contractility, clinical manifestations of patients with palpitations, chest tightness, rapid heartbeat, first heart low blunt, severe can lead to cardiac insufficiency. The common PR interval of ECG is prolonged, which may be due to the lesions affecting the atrioventricular node or vagus nerve.
The lesion mainly involves the connective tissue of the myocardial interstitial, especially the connective tissue around the small blood vessels. Mucinous degeneration and fibrinoid necrosis occur in the myocardial interstitial connective tissue in the early stage of the lesion, which in turn forms a rheumatoid body. The rheumatoid small body is distributed in a fusiform shape and has different sizes. It occurs in the myocardium, but there are more ventricular septum, left ventricle posterior wall, left atrium and left atrial appendage. In the later stage of the lesion, the rheumatoid corpuscle is fibrotic, forming a fusiform small scar. Myocarditis in children is often diffuse interstitial myocarditis.
In rheumatic myocarditis, the formation of scars in the myocardial interstitium is gradually different from the formation of scars affecting myocardial contractility, clinically manifested as rapid heartbeat, the first heart sound is low and blunt. This may be due to lesions that affect the excitability of the atrioventricular node or vagus nerve.
Examine
Rheumatic myocarditis check
1. Electrocardiogram: The common PR interval of ECG is prolonged, which may be caused by the lesions affecting the atrioventricular node or vagus nerve.
2, X-ray examination: due to the extent of the lesion and the severity of the lesion, the radiation examination is also quite different, about 1/3-1/2 of the heart is enlarged, mostly mild to moderate expansion.
Diagnosis
Diagnosis and diagnosis of rheumatic myocarditis
diagnosis
Diagnosis can be based on the cause, clinical symptoms and related tests.
Differential diagnosis
1. Toxic myocarditis
Have a history of serious infection or drug poisoning, often complicated by severe pneumonia, typhoid fever, sepsis, diphtheria, scarlet fever and other diseases, often with the improvement of the symptoms of the primary disease and gradually recover, using ipecaine, expectorant, etc. can cause myocarditis, with The drug is reduced or deactivated and gradually improved or recovered.
2, rheumatic carditis
Have a history of recurrent respiratory infections, symptoms of rheumatism such as high fever, multiple migratory arthritis, ring erythema and subcutaneous nodules, mitral systolic and/or diastolic murmurs in valvular lesions, laboratory examination Evidence of increased ESR, positive C-reactive protein, increased mucin and anti-hemolytic streptococcus "O", increased streptococcal kinase titer and positive for throat swab culture.
