呈急性心肌梗死样表现的暴发性心肌炎11例

Fulminant myocarditis mimicking acute myocardial infarction

目的分析呈急性心肌梗死样表现的暴发性心肌炎临床特点及治疗方法.方法研究对象符合①45岁以下;②无高血压、高脂血症、糖尿病、吸烟等常见的动脉粥样硬化危险因素;③既往无心绞痛表现;④心肌酶学增高（较正常参考值高2倍以上）;⑤ECG除极相及（或）复极相出现较典型的AMI样改变,即出现异常Q波、ST段抬高或压低;⑥1个月内恢复正常或死亡者.从临床表现、辅助检查及治疗等方面进行分析.结果共11例入选,男性7例,女性4例,平均年龄26岁.8例有前驱感染症状,9例发生心功能不全或室速或严重的房室传导阻滞,10例患者心电图多导联出现异常.根据心超表现分为3型,Ⅰ型3例为心脏结构、心脏收缩功能及舒张功能均无明显异常;Ⅱ型4例为心室腔不增大,但室壁（室间隔或正后壁）增厚,心脏收缩功能及舒张功能均减退,但以舒张功能不全为主;Ⅲ型4例为左心室腔明显扩大,心脏收缩功能明显减退.糖皮质激素对2型效果好.存活7例,经1～2年随访逐渐恢复.结论呈急性心肌梗死样表现的暴发性心肌炎病情重、死亡率高,多有前驱感染症状,常出现多导联心电图异常,依据心超表现的分型对治疗与预后有重要意义.

Purpose To study the clinical manifestation and treatment of fulminant myocarditis mimicking acute myocardial infarction. Methods Patients who were enrolled met the following criteria： ①Age 445 years; ②No classic risk factors for atherosclerosis, such as hypertension, dyslipidemia, diabetes mellitus, smoking and so on; ③ No history of angina pectoris;④ Increased levels of cardiac biomarkers （more than double normal value） ; ⑤ Findings in electrocardiogram （ECG） were compatible with that of acute myocardial infarction; ⑥Recovered or died during one month. Their clinical data were analyzed Results Of 11 eligible patients, 7 were male, 4 were female. Mean age was 26 years. Eight patients had proceeding flu-like symptom. Nine patients suffered from heart failure or ventricular tachycardia or severe atrio-ventricular block, The ECG abnormalities were seen in anterior precordial leads and inferior leads in 10 patients. Three types were classified based on echocardiogram, type Ⅰ （n = 3） were defined as normal left ventricular （LV） construction with nearly normal function; typeⅡ（n = 4） was characterized by increased ventricular wall thickness, systolic dysfunction without LV dilatation; type Ⅲ （n = 4） presented with abnormal LV contraction dimensions, increased ventricular wall thickness. Corticosteroid therapy was effective in the type Ⅱ. Survivors （n = 7） recovered gradually during the 1-2 years follow-up. Conclusions Fulminant myocarditis mimicking acute myocardial infarction was a kind of fatal disease; patients usually had proceeding flu-like symptom, and diffusely ECG abnormalities, the classification based on echocardiogram played an important role in the treatment and prognosis.