Patient's question:
On the day of the high fever, there was a long inhalation, followed by an elevated CK-MB level 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 lead to cardiogenic shock or acute congestive heart failure, resulting in 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 in older children, discomfort in the precordial area, palpitations, dizziness, abdominal pain, and muscle pain. Physical examination often reveals a dull first heart sound, gallops, tachycardia or bradycardia, or arrhythmias. Due to pericarditis, a pericardial friction rub may be heard, with normal or enlarged cardiac borders, decreased blood pressure, and weak pulses. Depending 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 waves, 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 occurs within weeks or months with treatment, or it may follow an asymptomatic course.
(2) Moderate Type: In addition to the above symptoms, congestive heart failure is often present, with a more acute onset. The child may refuse food, appear pale, have dry cough, and experience dyspnea with mild coughing. Older children may complain of precordial pain, dizziness, palpitations, acute abdominal pain, and muscle pain. Symptoms may include dyspnea, orthopnea, restlessness, cyanosis, enlarged cardiac borders, dull heart sounds, and left gallops or arrhythmias. Reappearance of rales in both lungs, hepatomegaly with tenderness, and often mild edema. Secondary neurological and renal damage may also occur. With timely treatment, most cases can recover fully 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 lead to cardiogenic shock, with the child appearing restless, dyspneic, pale, with peripheral cyanosis, cold and sweaty skin, weak pulses, decreased or unmeasurable blood pressure, tachycardia, and gallops. Some children may develop severe abdominal or muscle pain, with a rapidly progressing condition. If treatment is delayed, death may occur within hours or months. Severe cases 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, significant edema, and death from controlled heart failure. Chronic cases often exhibit thrombotic phenomena or arrhythmias. Thrombosis in the brain may cause hemiplegia or aphasia, while renal thrombosis may cause hematuria. Very few cases may develop myocardial infarction. Severe arrhythmias, such as complete heart block, ventricular tachycardia, or ventricular fibrillation, may lead to sudden death.