| [Background] According to the latest diagosis standard of acute viral myocarditis,there should be a interval after virus infect over 1 weeks before onset.However,fulnimant myocarditis because of insidious onset,progress rapidly could complicate fatal arrhythmias,heart failure,multiple organ failure within a short time.If we cannot diagnosis timely,patients would miss the optimal time for treatment and rescue,and with a poor prognosis.[Objective] To review the clinical features of fulminant myocartitis,in order to provide assistance to the clinical management.[Methods] The clinic data of 183 patients with viral myocarditis,including153 cases of acute myocarditis and 30 cases of fulminant myocarditis admitted in our hospital during January 2008 and Dec 2012 were retrospectively analyzed.The age of onset,interval after virus infect,initial symptoms,auxiliary examination,treatment,and turnover were compared in the study.[Results] The average onset age of fulminant myocartitis and acute myocarditis were similar[(22.3±7.6)vs(26.2±12.6)years,P=0.1055].There was a significant difference between the two gourps in the rate of patients with a explicit history of virus infection[30.0%(9/30)vs 78.4%(120/153),χ2=28.3,P<0.001],the average interval after virus infect [(3.1 ± 2.2)vs(7.0 ± 3.80)d,P<0.001] and the length of hospital stay[(12.1 ± 6.9)vs(6.9 ± 4.50)d,P<0.001].Chest congestion(101/153,66.0%),feebleness(76/153,49.7%),fluster(74/153,48.4%)are the most onset symptoms of acute myocarditis,while chest congestion(24/30,80.0%),shortness of breath(14/30,46.7%),feebleness(13/30,43.3%)in flunimant myocarditis.Advanced A-V block(19/30,63.3%),cardiogenic shock(18/30,60.0%),ventricular arrhythmia(16/30,53.3%),Adams-Stokes syndrome(8/30,26.67%)and acute renal failure(8/30,26.7%)were the most complications of flunimant myocarditis.Temporary pacemaker(11 cases),extracorporeal memberane exygenator(7 cases)and intra-aortic balloon pump(7 cases)were applied in critical patients.In acute phase,21 cases were cured,9 cases was dead of cardiogenic shock and ventricular(27,30.0%).Two dead cases applied with ECMO because of delay.These dead cases were died within one week after be in hostipital.Low ventricular ejection fraction(P=0.032),cardiogenic shock(P=0.004),and mechanical ventilation(P=0.001)were relatived with dead of fulminant myocarditis in acute phase.Three cases with low left ventricular ejection fraction(EF<50%)who reviewed the echocardiography was normal one month later.Besides 11 cases with ST-T wave imitated myocardiac infarction was normal one month later.In follow-up of 21 cases fulminant myocarditis,their heart functions were recovered(NYHA I),and 2 cases relapsed,while 2 cases relapsed in the follow-up of 50 cases of acute myocarditis.The relapsed cases all dignosed with acute myocarditis,and cured by nutritional supportive therapy.There is no significant difference between 2 groups(P=0.357).[Conclusions] The fulminant myocarditis has a rapid onset,most of which has no prodrome of virus infection or a shorter interval than acute myocarditis.Timely and effective mechanical circulatory support is critical for fulminant myocarditis.The prognosis of fulminant myocarditis is favorable,and these is no difference compared with acute myocarditis. |
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