Even if it is myocarditis caused by infection, it is not just viral infection, fungi, parasites and bacteria can infect the myocardium. However, myocarditis caused by viruses is the most common in clinical practice, and the old doctor's mantra of viral myocarditis has come to be known.
When clinicians discuss myocarditis, they generally focus on viral myocarditis, because nine out of ten patients are infected by viruses.
Dilated cardiomyopathy, like myocarditis, is caused by immune factors and viral infections. Among them, enterovirus and cytomegalovirus infections detected in myocardial biopsy have been confirmed to be directly related to dilated cardiomyopathy. Coincidentally
Yes, myocarditis is also affected by these two viruses.
This is the point of contention between Li Chengyuan and Dr. Dong. Indeed, it is currently unclear whether the infection caused the occurrence of two diseases at the same time, or whether one disease occurred first and then gradually led to the emergence of the other disease.
What is the significance of this debate? It lies in the latent myocarditis mentioned by Xie Wanying just now. Clinicians failed to detect and perform examinations in time, which ultimately led to the death of heart failure patients.
Li Chengyuan denied her statement and believed that the patient did not have latent myocarditis at all. He had dilated cardiomyopathy at the beginning, so it could not be detected clinically. The initial symptoms of dilated cardiomyopathy can be more subtle, with a slow onset, and can lead to severe symptoms.
The course of the disease can last for more than ten years.
Dr. Dong agrees with Xie Wanying's point of view, which means he believes that as long as it is a viral myocardial infection, there should be a process from myocarditis to dilated cardiomyopathy. The reason is that he has seen many such patients in clinical practice.
This is the difference between an internist and a surgeon. Patients with myocarditis generally do not go to cardiothoracic surgery. They first go to the cardiovascular department for drug treatment. It is not until the patient has complete heart failure and is considering a heart transplant that he will be transferred to surgery.
When performing surgery, the surgeon only recognizes the anatomical results. Myocarditis is the deformation and necrosis of myocardial cells, while dilated cardiomyopathy is characterized by ventricular enlargement. How can it be the same?
"Persistent myocarditis will lead to myocardial remodeling," Xie Wanying said.
"Yes. As she said, that's it." Dr. Dong clapped his hands and applauded her words.
Li Chengyuan did not back down: "Your statement cannot 100% prove that dilated cardiomyopathy comes from persistent myocarditis. It is possible that both occur at the same time."
Xie Wanying suddenly thought of something and stopped talking after listening to her senior's words.
Huang Zhilei and Xin Yanjun whispered: "The two of them were quarreling, what exactly were they quarreling about? Now we should suspect it is myocarditis, right?"
Elevated troponin represents myocardial damage. As one of the important indicators to assist in the diagnosis of myocarditis, it has clinical guidance value. To diagnose myocarditis, the patient needs to have clinical symptoms related to myocarditis, such as chest pain, chest tightness, breathlessness, heart failure, and palpitations. If
If the patient does not have obvious symptoms, other examinations are needed to confirm whether it is myocarditis. Therefore, this patient is now in the initial stage of the doctor's suspicion of myocarditis. Next, the patient should undergo electrocardiography and echocardiography as soon as possible.
If you want to ask about the gold standard for myocarditis, it must be endocardial myocardial tissue biopsy.
Since Xie Wanying's auscultation revealed the possibility of ventricular dilation in the patient, at the suggestion of Dr. Li Chengyuan, it was suspected that dilated cardiomyopathy should be added to the diagnosis.