病毒性心肌炎2课件

1、病 毒 性 心 肌 炎Viral myocarditis,VMCOutlineViral myocarditis results due to the viral invasion of the myocardium Etiologyviral infection Enterobacteria、RSV RNA viruses especiallyCVB1-6 and A1-9。RNA Virus DNA VirusThe virus to cause human myocarditisMechanismviral infectionImmune systemcell damagemyocard

2、ial Ag exposed, surface Ag changedNatural killer cell infiltrationinflamatory necrosis of myocardial cells，lymphocytes infiltrationHemodynamic changesInflammation of the heartCardiac enlargementRenal blood flowBlood volumEDVLA pressurePV extravasated bloodRight heart extravasated bloodHepatomegaly+s

3、ubcutaneous edemaCHFstimulation of SNSAfterloadPreloadProdrome： viral enteritissymptom： light moderate severePhysical Examination： range form light to severe Clinical Manifestation PEShortness of breathcyanosisLow heart sound ,GallopLung auscultationHepatospleno-megalyClinical Manifestation Clinical

4、 classification1.slight2.moderate3.Severe InvestigationsX-Ray:Enlarged heart shadow，ingcreased lung markingsNormal X-Ray Atrial premature beats Ventricular premature beatsAtrial Fibrillation Ventricular TachycardiaAtrioventricular block IIIIIII Ventricular pulse weakenedLV enlargement Investigations

5、 -ECHO Heart ECT Perfusion defect of theLeft ventricular posterior wall and lateral wallInvestigations myocardial blood biochemical indexes CKand LDH Increase in the early stage is significant CKMB mainly rise of CKMB cTnI /cTnT Specific for diagnosisInvestigations Virological diagnosis Nasopharynge

6、al swabPharyngeal washing fluidStoolBloodMyocardial biopsy golden criteriaIsolated the virusCombined with serum Ab中国儿童病毒性心肌炎诊断标准（1999年修订）2.Etiological diagnosis ： 1、确诊指标：自患儿心内膜、心肌、心包（活检或病理）、 心包穿刺液检查发现以下之一者可确诊心肌炎由病毒引起： 分离到病毒 用病毒核酸探针查到病毒核酸 特异性病毒抗体阳性 2、参考依据： 有以下之一者结合临床表现可考虑心肌炎系病毒引起： 自粪便、咽拭子或血液中分离到病毒且恢复

7、期 血清同型抗体滴度较第一份血清升高或降低4倍以上 病程早期患儿血中特异性IgM抗体阳性 用病毒核酸探针自患儿血中查到病毒核酸Diagnosis中国儿童病毒性心肌炎诊断标准（1999年修订）3.Diagnosis basis： 1、同时具备病原学确诊依据之一者，可确诊为病毒性心肌炎 2、具备病原学参考依据之一者，可临床诊断为病毒性心肌炎 3、凡不具备确诊依据，应给予必要的治疗或随诊，根据病情变化，确诊或除外心肌炎 应除外风湿性心肌炎，中毒性心肌炎，先天性心脏病，结缔组织疾病及代谢性疾病的心肌损害，甲状腺功能亢进症，原发性心肌病，原发性心内膜弹力纤维增生症，先天性房室传导阻滞，心脏自主神经功能异常，-受体功能亢进及药物引起的心电图改变Diagnosis Depending on the severity of myocardial lesions,wether treatment is timely or adequate rest1.mostly