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Myocarditis and Fulminant Myocarditis

Symptom. Previous history of flu-like syndromesChest discomfortOthers: Dizziness, Syncope, Palpitation, Thrombosis, Embolism. Sign. Tachycardia, Hypotension, FeverHeart Enlargement, MR, TRHeart failure sign: Jugular vein engorgement, pulmonary rale, wheezing, rubs, peripheral edema. Lab data. Ca

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Myocarditis and Fulminant Myocarditis

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    1. Myocarditis and Fulminant Myocarditis ???:Ri??? 91-6-26

    2. Symptom Previous history of flu-like syndromes Chest discomfort Others: Dizziness, Syncope, Palpitation, Thrombosis, Embolism

    3. Sign Tachycardia, Hypotension, Fever Heart Enlargement, MR, TR Heart failure sign: Jugular vein engorgement, pulmonary rale, wheezing, rubs, peripheral edema

    4. Lab data Cardiac enzyme EKG: Sinus tachycardia, ST-T change, Arrhythmia(PSVT), conduction block Echo: LV dysfunction with or without LV dilatation, ejection fraction?

    5. Fulminant myocarditis Distinct onset of symptoms within 1-2 days severe cardiogenic heart failure arrhythmia fever

    6. Etiology(I) Infectional: Virus: Enterovirus, Adenovirus, HIV, Hepatitis C, HSV, Parvovirus Bacteria: streptococci, Corynebacterium diphtheria, Haemophilus influenza, Serratia marcescens, Treponema pallidum

    7. Etiology(II) Protozoal: Toxoplasma gondii, Trypanosoma cruzi Parasitic: Echinococcus granulosus, Paragonimus westermani, Taenia solium, Trichinella spiralis, Wuchereria bancrofti Rickettsial, borrelia, leptospira

    8. Etiology(III) Non-infectional: Toxic: Anthracycline, ethanol Allergic: Autoimmune: Chlamydia pneumoniae, scleroderma, SLE,

    9. Diagnosis(I) Clinical symptom: clinical heart failure, recent flu-like syndrome, arrhythmia Invasive : myocardial biopsy-histological characteristics(Dallas criteria), myocyte PCR

    10. Endomyocardial Biopsy(EMB) Gold standard Dallas criteria: extensive inflammatory cell infiltration with myocyte necrosis Disadvantages: limited sensitivity and specificity, invasive procedure

    11. Diagnosis(II) Serological: CK, troponin-I, troponin-T, CRP, ESR, leukocytosis

    12. Diagnosis(III) Noninvasive EKG, Echo, Antimyosin scintigraphy, contrast enhanced MRI, echocardiographic digital image processing, cine magnetic resonance angiography

    13. Treatment(I) Supportive care: diuretics ACEI vasodilators(NTG, sodium nitroprusside) hospitalized, Bed rest ?: digoxin, NSAIDs, sympathomimetic, beta-blocker

    14. Treatment Aggressive therapy implantation of ventricular assist device (LVAD, BVAD) ECMO implantation of defibrillator immunosuppressant (e.g. IVIG)

    15. Fulminant myocarditis Supportive + Aggressive care Heart transplant should be avoided Prognosis: This disease is fatal in early stage, but fully recover is possible if early diagnosis and aggressive treatment is given. Its prognosis is excellent.

    16. Thank you very much .

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