Patient's question:
On the day of the high fever, there was a long inhalation before, and then an elevated myocardial enzyme by 10 points. Troponin was 12 times higher. The hospital diagnosed myocarditis. A week before, there was coughing, followed by a long inhalation, and then high fever.Previous treatment history and effectiveness: A 15-day course...
Doctor's answer:
Clinical manifestations vary greatly, ranging from asymptomatic cases in mild severity to severe cases that may develop cardiogenic shock or acute congestive heart failure, leading to death within hours or months.Several months or two weeks before the recurrence of cardiac symptoms, respiratory or intestinal infections may occur, accompanied by moderate fever, sore throat, nausea, vomiting, and rashes, followed by the reappearance of cardiac symptoms. The main symptoms include fatigue, poor appetite, nausea, dry cough, dyspnea, pallor, fever, and chest discomfort in older children. Physical examination often reveals a dull first heart sound, gallops, tachycardia or bradycardia, or arrhythmias. Due to pericarditis, a friction rub may be heard, and the cardiac borders may be normal or enlarged. Blood pressure may drop, and the pulse may be weak. Based on the severity, the condition can be classified into mild, moderate, and severe types.
(1) Mild Type: May be asymptomatic or show only transient changes in ECG ST-T segments, or manifest as poor mental state, weakness, poor appetite, a weak first heart sound, or gallops, tachycardia, with mostly normal cardiac borders. The condition is relatively mild, and full recovery may occur within weeks or months, or it may follow an asymptomatic course.
(2) Moderate Type: In addition to the above symptoms, congestive heart failure is common, with acute onset. The child may refuse food, appear pale, have dry cough, and experience dyspnea with mild cough. Older children may complain of chest pain, dizziness, palpitations, acute abdominal pain, and muscle pain. Symptoms may include dyspnea, orthopnea, restlessness, cyanosis, enlarged cardiac borders, dull heart sounds, gallops, or arrhythmias. Repeated rales may be heard in both lungs, hepatomegaly with tenderness, and edema may be mild. Secondary neurological and renal damage may occur. With timely treatment, most cases can fully recover within months or years, though some may die during the acute phase due to acute congestive heart failure or leave behind residual myocardial damage.
(3) Severe Type: May develop cardiogenic shock, with the child appearing restless, dyspneic, pale, with peripheral cyanosis, cold and sweaty skin, weak pulses, and hypotension or unmeasurable blood pressure. Tachycardia and gallops may be present. Some children may experience severe abdominal pain or muscle pain, with rapidly worsening conditions. If treatment is delayed, death may occur within hours or months. The severe type may also present with acute or chronic congestive heart failure, with symptoms similar to moderate cases. Some may die due to uncontrolled acute heart failure, while a few cases may transition from acute to chronic, with recurrent heart failure due to infection or overexertion, leading to years of severe symptoms, marked cardiac atrophy, dyspnea, hepatomegaly, and obvious edema. Death may occur due to controlled heart failure.
Chronic cases often show embolic phenomena, such as stroke or arrhythmias. Embolism in the brain may cause hemiplegia or aphasia, while renal embolism may cause hematuria. Myocardial infarction may occur in very few cases. Severe arrhythmias, such as complete AV block, ventricular tachycardia, or ventricular fibrillation, may lead to sudden death.