酷似心肌梗死的重症病毒性心肌炎的临床分析

Clinical analysis of severe viral myocarditis mimicking acute myocardial infarction in patients.

目的探讨酷似心肌梗死的急性重症病毒性心肌炎的诊断和治疗。方法收集临床表现酷似心肌梗死、经冠状动脉造影示冠脉正常的重症病毒性心肌炎患者38例。分析归纳该病的发病机制、临床特征、治疗及预后。结果经及时确诊并采取相应治疗后21例患者乏力、胸痛、心悸、气促等症状明显好转,心肌酶、心电图及超声心动图恢复大致正常范围;5例患者阵发性心悸,发作时心电图分别示窦性心动过速、窦性心动过缓、频发室性早搏;2例发作性胸闷、胸痛,心电图示ST-T改变（ST段下移0.1-0.2mV,T波低平）;2例心电图遗留Ⅰ度房室传导阻滞;1例左束支传导阻滞;3例偶发早搏;1例发展为扩张型心肌病;3例急性期死亡。结论酷似心肌梗死的病毒性心肌炎,其临床表现、心电图、心肌酶改变酷似急性心肌梗死。因此,注重把握临床资料,及时掌握客观诊断依据,积极合理诊治是临床医生值得重视的问题。

Objective Aim of this study was to assess the diagnosis and therapy of myocarditis in patients presenting with acute myocardial infarction and normal coronary angiograms. Methods Thirty-eight patients with clinical signs and symptoms consistent with acute myocardial infarction after angiographic identification of normal coronary. The clinical coursa and characteristics in all patients were analyzed. Results In 21 patients fatigue, chest pain, palpitation, shortness of breath was relieved greatly, serum enzyme,ECG.echocardiogramphy show normal sign; 5 patients with paroxysmal palpitation presented sinus tachycardia .sinus bradycardia, frequent ventricular premature beat;2 patients with paroxysmal chest distress presented STT changes（ST segment depression 0. 1-0. 2 mV,T wave flat）; 2 patients presented I^o auriculoventricular block; 1 patient presented left bundle branch block; 3 patients presented incidental premature beat ; 1 patient progressed to dilated cardiomyopathy; 3 patients died in acute period. Conclusion Clinical diagnosis of mainly depends on patients＇s clinical sign and objective evidence of myocardial injury. Early diagnosis and successful treatment can be done.