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心肌炎

最后审阅: 12 Nov 2024
最后更新: 12 Jul 2023

小结

定义

病史和体格检查

关键诊断因素

  • 存在的危险因素
  • (既往)病毒性综合征
  • 自身免疫性疾病
  • 传染病
  • 药物及毒素
完整详情

其他诊断因素

  • 年龄<50岁
  • 胸痛
  • 呼吸困难
  • 端坐呼吸
  • 疲劳
  • 心悸
  • 啰音
  • 颈静脉鼓起
  • S3 奔马律
  • 窦性心动过速
  • 房性和室性心律失常
  • 呼吸急促
  • 肝肿大
  • 晕厥
  • 发热
  • 胃肠道问题
  • 鼻溢(流涕)
  • 咳嗽
  • S3 和 S4重迭奔马律
  • 心包摩擦音
  • 外周灌注不足
  • 低血压
  • 感觉异常
  • 淋巴结肿大
  • 呼吸窘迫
完整详情

危险因素

  • 感染(非HIV)
  • HIV 感染
  • 自身免疫性/免疫介导的疾病
  • 围产期和产后期
  • 药物及毒素
完整详情

诊断性检查

首要检查

  • 12 导联心电图
  • 胸部 X 线检查 (CXR)
  • 血清肌酸激酶 (CK)
  • 血清 CK-MB
  • 血清肌钙蛋白(I 或 T)
  • 血清 B 型利钠肽
  • 二维超声心动图
  • 18 氟-氟代脱氧葡萄糖正电子发射断层扫描(18F-FDG-PET-CT)
完整详情

需考虑的检查

  • 心内膜心肌活检 (EMB)
  • 冠状动脉造影
  • 心脏磁共振成像
  • 病毒聚合酶链反应 (polymerase chain reaction, PCR)
完整详情

新兴检查

  • MRI引导的EMB

治疗流程

急症处理

血流动力学稳定:没有左心室收缩功能障碍的证据

血流动力学稳定:有 LV 收缩功能障碍的证据

血液动力学不稳定:成人

血液动力学不稳定:儿童

持续性治疗

末期心力衰竭或难治性致死性心律失常

撰稿人

作者

Shriprasad R. Deshpande, MBBS, MS

Medical Director

Heart Transplant and Advanced Cardiac Therapies Program

Children's National Hospital

Associate Professor of Pediatrics

The George Washington University

Washington

DC

利益声明

SRD declares that he has no competing interests.

Bibhuti Das, MBBS, MD, FAAP, FACC

Pediatric Cardiology

Chief, McLane Children’s Hospital, BSW Medical Center

Baylor Scott and White Medical Center

Professor of Pediatrics

Baylor College of Medicine-Temple

Director of ACHD and CPET

Temple

TX

利益声明

BD declares that he has no competing interests.

鸣谢

Dr Shriprasad R. Deshpande and Dr Bibhuti Das would like to gratefully acknowledge Dr Katherine C. Wu, Dr James E. Harvey, and Dr Arman T. Askari, previous contributors to this topic. KCW, JEH, and ATA declare that they have no competing interests.

同行评议者

David A. Leaf, MD, MPH

Professor of Medicine

School of Medicine

VA Greater Los Angeles Healthcare System

UCLA

Los Angeles

CA

利益声明

DAL declares that he has no competing interests.

John Charpie, MD, PhD

Associate Professor of Pediatrics

Medical Director

Pediatric Cardiothoracic Intensive Care Unit

University of Michigan Congenital Heart Center

Ann Arbor

MI

利益声明

JC declares that he has no competing interests.

Lokesh Tejwani, MD, FACC

Assistant Professor of Clinical Medicine

University of Missouri Hospitals and Clinics

Harry S. Truman VA Hospital

Columbia

MO

利益声明

LT declares that he has no competing interests.

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