Is acute myocarditis serious?

The onset of acute myocarditis is very serious. If not controlled in time, it may develop into chronic myocarditis or even multiple complications of myocarditis. Patients with acute myocarditis should master the key points of diagnosis. If the patient has symptoms of chest tightness, chest pain, nausea and vomiting, timely examination and diagnosis should be carried out. Regular physical examinations and inspections should be done.

Diagnostic points

(1) It often occurs during the active phase of rheumatic fever or is secondary to other infectious diseases and chemical drug poisoning.

(2) Clinical manifestations include palpitations, shortness of breath, chest tightness and chest pain.

(3) Physical examination may reveal an accelerated heart rate, an enlarged heart, a weakened first heart sound, a diastolic gallop rhythm, and systolic murmurs in each valve area. In severe cases, heart failure or cardiogenic shock may occur.

(4) Laboratory tests may show: ① increased white blood cell count; ② accelerated erythrocyte sedimentation rate; ③ increased aspartate aminotransferase, lactate dehydrogenase and creatine kinase.

(5) X-ray examination may show an enlarged heart, mainly to the left.

(6) ECG changes may include various arrhythmias, conduction block and nonspecific ST segment elevation, T wave inversion and QT interval prolongation.

Differential Diagnosis

(1) Cardiomyopathy

There is no systolic murmur caused by valvular disease, the serum anti-myocardial antibody titer is greater than 1:32, the erythrocyte sedimentation rate is generally not high, and LDH and CPK are not increased, which can be distinguished from acute myocarditis.

(2) Keshan disease

It is an endemic disease with epidemiological characteristics, and left bundle branch block is the most common finding on the electrocardiogram.

(3) Acute rheumatic fever

Except for acute myocarditis, there are no other clinical manifestations and signs such as fever, migratory arthritis, skin lesions, chorea, etc.

Emergency treatment

(1) Absolute bed rest and a diet high in protein, multivitamins and easily digestible foods.

(2) In case of heart failure, the patient should sit upright with both lower limbs hanging down or in a semi-recumbent position. The limbs can also be ligated alternately to reduce the amount of blood returning to the heart and relieve the heart load.

(3) If the patient is in shock, he/she should lie flat with his/her head slightly lowered, and foreign objects in the mouth should be removed promptly to keep the airway open.

(4) If severe heart failure or shock occurs, the patient should be sent to the hospital for treatment immediately.