Myocarditis varies in severity. Mild cases can have no conscious symptoms; In severe cases, cardiogenic shock, heart failure and sudden death due to severe arrhythmia may occur. Myocarditis mainly has the following typical symptoms:
Prodromal symptom
Most patients with viral myocarditis have prodromal symptoms of viral infection 1 to 3 weeks before the onset, such as fever, general fatigue, muscle aches, or nausea, vomiting and other gastrointestinal symptoms.
Many of these symptoms are not directly related to heart trouble and are therefore easy to ignore. There are also some patients whose prodromal symptoms are very insignificant and go directly into acute attack symptoms.
Acute attack symptom
Moderate to severe fatigue, palpitation, chest tightness, shortness of breath, chest pain, dizziness, may become worse within 1 to 3 days;
Severe patients may also have symptoms of acute left heart failure, including dyspnea, lower limb edema, etc.
More critically ill or fulminant patients may experience syncope or even sudden death without many prodromal symptoms or discomfort.
The most common discomfort in most patients with viral myocarditis is palpitations, chest tightness, feeling that the heart occasionally "stops" (premature beat, irregular heartbeat), and the symptoms of discomfort during exercise or excitement are obvious.
Recurrent or prolonged symptoms
Some myocarditis from acute to recurrent or prolonged, the course of disease more than 6 months. Patients with easy fatigue, palpitations, chest tightness, chest pain, sporadic heart "stop" (premature beat, irregular heartbeat), after exercise discomfort aggravated, prolonged may be further aggravated, manifested as suffrage, edema, etc.
Myocarditis how to see a doctor
When a patient develops a series of cardiac abnormalities within 3 weeks after the occurrence of upper respiratory tract infection, diarrhea and other viral infection symptoms, such as severe fatigue, palpitations, chest tightness, shortness of breath, chest pain, dizziness, and even syncope, it is necessary to be alert to the possibility of myocarditis and seek medical attention as soon as possible.
Department for treatment
The disease is mainly diagnosed and treated in the cardiovascular department, some patients are in critical condition and need emergency treatment. In addition, because the patients with the disease may have upper respiratory tract infection or diarrhea in the early stage, sometimes they will be treated in the fever clinic, respiratory medicine, infection department, etc.
Cardiovascular medicine (cardiology) : When there are palpitations, chest tightness, chest pain, dyspnea, lower limb edema, etc.
Emergency Department: Emergency situations such as fainting, severe dyspnea, chest pain, etc., need to see a doctor immediately and call the emergency number in time.
Correlation check
General physical examination: The doctor will ask about symptoms, medical history, cardiac auscultation, etc.
Electrocardiogram: Arrhythmia, ST-T changes and other symptoms can be found.
X-ray examination: The morphologic changes of the heart can be detected. Most patients have small heart shadow; Some patients can find enlarged heart shadow; Left heart insufficiency may have pulmonary congestion and pulmonary edema signs; In patients with pericardial effusion, the heart shadow can be changed like a flask.
Echocardiography: can determine whether there is cardiac enlargement, wall thickness and movement, cardiac systolic function, pericardial effusion, etc.
Laboratory tests: Patients with myocarditis show elevated troponin (T or I), creatine kinase isoenzyme (CK-MB), erythrocyte sedimentation rate, C-reactive protein and other non-specific inflammatory indicators. At the same time, the level of B-type natriuretic peptide (BNP) or N-terminal B-type natriuretic peptide (NT-proBNP) can also indicate the degree of cardiac function impairment.
Coronary angiography: For clinically suspected myocarditis, but with ischemic or infarct changes in the electrocardiogram, or in older patients who need to rule out acute myocardial infarction, coronary angiography should be performed to confirm the diagnosis.
Cardiac magnetic resonance imaging: This test is of great value in the diagnosis of myocarditis. The typical manifestation is gadolinium delayed enhancement, with myocardial lamellar enhancement seen on scan.
Viral serological testing: Viral serological testing helps in early diagnosis, and viral genetic testing is available when conditions permit, helping to identify the pathogen.
Endocardial myocardial biopsy: Myocardial biopsy is still the gold standard in the diagnosis of myocarditis. Because it is an invasive examination, it is generally not used as a routine examination, but for patients with acute illness, poor treatment response, and unknown causes, it is helpful to judge the condition and prognosis.
The examination arrangement and judgment of myocarditis have very high professional requirements, which require the guidance and interpretation of professional doctors.
