| [Objective]By reviewing the clinical information of acute severe viral myocarditis in adult of our hospital in the 10 years, the clinical diagnosis and treatment are analyzed and summarized, so that these patients can receive diagnosis and treatment as soon as possible according to the result, the survival rate is improved and the clinical work can be guide better.[Methods]The clinical information of 60 cases of acute severe viral myocarditis in adult who received treatment in our hospital during Jan 2001 and Dec 2010 is reviewed in retrospective analysis. The age of onset, male female ratio, initial symptoms, result of auxiliary examination, treatment, turnover, prognosis including the symptoms, echocardiography of 6 to 12 months'follow up were analyzed and summarized. The Kansas City Cardiomyopathy Questionnaire was done while cardiac symptoms were also recorded by telephone interview or out-patient follow up, in order to evaluate the living quality of patients. Using the SPSS17.0 Statistical analysis software to analyze the data above and give the conclusion.[Results]Among the 60 cases, the average age of onset was (30.10±14.98) years. 86.7%(52 cases)patients were suffered from the virus infection. Tachypnea, dyspnea, chest pain were the most common initial symptoms. The most common complications were acute myocardial infarction liked myocarditis, acute left heart dysfunction and Adams-Stokes syndrome. Troponin is positive. Myocardial markers were elevated in a large number of patients and persisted for 2 to 3 weeks, and enzyme peak occured in the eighth day after the sign came on. LHD peak (P<0.05) of Cured group and death group had significant difference. ECGs were abnormal in all patients, ST-T change was most common, usually combined other arrhythmia. The results of echocardiography showed that systole and diastolic function of the heart were weak. The LVEF and LVDs in echocardiography in post-treatment and follow-up were better than that before treatment (P<0.01). The usage of glucocorticoid was 98%. The application of methylprednisolone was 40mg qd before 2008, and the cured rate was 83.78%. The application of methylprednisolone was 500mg qd after 2008, and the cured rate was 77.27%. But neither of these rates had significant difference. The usage of IVIG was 60%,48.15% before 2008, the cured rate was 85.29%. The usage of it was 63.64% after 2008, the cured was 70.08%. But neither of two cured rates had significant difference. The usage of IABP improved after 2007. 48 cases were cured in the acute phase, 8 cases were dead, and 4 cases left hospital voluntarily as critically ill, 6 cases remained cardiomegaly with or without clinical cardiac signs. 2 of them were diagnosed as dilated cardiomyopathy and LVEF < 50% by echocardiography. The prognoses were good in the rest of the healing patients and the heart function became normal. The average scores of The Kansas City Cardiomyopathy Questionnaire in 39 patients was (90.21±5.0).[Conclusion]1,Manifestations of acute severe viral myocarditis in adult are various that generally present as prodrome of virus infection. Tachypnea, dyspnea, chest pain were the most common initial symptoms abnormal result of many auxiliary examinations which is lack of specificity. The most common complications were acute myocardial infarction liked myocarditis, acute left heart dysfunction and Adams-Stokes syndrome.2,The tendency of myocardial isoenzymes and the echocardiography may contribute to the diagnosis of acute severe viral myocarditis in adult.3,Treating the patient suffering acute severe viral myocarditis with IABP, glucocorticoid and IVIG early, the success rate may be high. |
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