I. Diagnostic basis
1, clinical diagnosis basis
(1) Cardiac insufficiency, cardiogenic shock or cardio-cerebral syndrome.
(2) Heart enlargement (X-ray, echocardiography has one of the manifestations).
(3) Electrocardiographic changes: ST-T changes in 2 or more major leads (I, II, aVF, V5) dominated by R waves for more than 4 days with dynamic changes, sinus atrioventricular block, atrioventricular block, complete right or left bundle of text block, premature beats in association, polymorphic, multiple sources, paired or parallel, ectopic tachycardia due to non-atrial node and atrioventricular folding, low voltage (except in neonates ) and abnormal Q waves.
(4) Elevated CK-MB or positive cardiac troponin (cTnI or cTnT).
2, pathogenetic diagnosis based on
(1) Confirmation index: Since the endocardium, myocardium, pericardium (biopsy, pathology) or pericardial puncture fluid examination of the child, one of the following can be found to confirm the diagnosis of myocarditis caused by virus. ① Viral nucleic acid was detected with a viral nucleic acid probe. ②Virus is isolated. (③) Positive antibodies to specific viruses.
(2) Reference basis: Myocarditis can be considered to be caused by a virus if one of the following is present in combination with clinical manifestations. ①Virus isolated from the child’s stool, pharyngeal swab or blood, and the recovery period serum isotype antibody titer than the first serum increased or decreased by more than 4 times. ②The specific IgM antibody in the blood of the resting child early in the course of the disease is positive. ③ Viral nucleic acid was detected in the blood of the child with a viral nucleic acid probe.
3.Confirmation of diagnosis based on
(1) With 2 clinical diagnostic bases, the clinical diagnosis of myocarditis can be made. If there is evidence of viral infection at the same time or 1 to 3 weeks before the onset of the disease to support the diagnosis.
(2)Those who have both one of the pathogenic confirmatory bases can be diagnosed as viral myocarditis, and those who have one of the pathogenic reference bases can be clinically diagnosed as viral myocarditis.
(3) Where no confirmatory basis is available, the necessary treatment or follow-up should be given to confirm or exclude myocarditis according to changes in the condition.
(4) Rheumatic myocarditis, toxic myocarditis, congenital heart disease, connective tissue disease and myocardial damage of metabolic diseases, hyperthyroidism, primary cardiomyopathy, primary endocardial elastosis, congenital atrioventricular block, cardiac autonomic abnormalities, beta-receptor hyperfunction and drug-induced electrocardiographic changes should be excluded.
4.Stage
(1) Acute stage: new onset, obvious and variable symptoms and positive findings, generally within six months.
(2) Extended period: recurrent clinical symptoms, objective examination indexes do not heal, and the duration of the disease is more than six months.
(3) Chronic phase: progressive heart enlargement, recurrent heart failure or arrhythmia, the disease is sometimes mild and severe, and the duration of the disease is more than one year.
Second, the examination related to diagnosis and efficacy observation
1.Discharge and admission examinations
(1)Routine electrocardiogram, exercise test, atropine test, comprehensive electrocardiogram, ambulatory electrocardiogram, electrocardiographic monitoring, selected according to the condition
(2)Cardiac enzymes, cardiac troponin
(3)CVB-IgM
(4)UCG or X-ray chest film
(5)Other scientific research examinations
2.In-course examination
(1)Exercise test, once a week, for atypical ECG cases
(2) ECG monitoring, once every 2 weeks, for cases with typical ECG changes
Chinese medicine diagnosis and treatment plan
Heat toxin invading the heart type
1. Symptom description: Recent history and symptoms of warm toxin infection, low fever that does not subside or repeated fever, sore throat, cough, rash, myalgia, accompanied by weakness, shortness of breath, palpitations, etc., red and vivid tongue, thin yellow moss, brownish, string or slippery pulse, the duration of the disease is mostly within one month, usually not more than three months, often the acute phase of myocarditis, if the disease is prolonged due to repeated infections, this type can also be considered. The main points of identification are: first, those who have obvious manifestations of heat toxicity; second, those who have a short duration of acute illness and only have a red throat.
2.Treatment plan
(1)Chinese herbal soup (Qingxin)
(2)Tongguo Combination
(3)Curcuma oil, or penetrating amber tranquil drops
(4) With weakness, weakness and susceptibility, add Huang Qi acupoint injection
Qi and Yin deficiency type
1, symptom description: pale face, obvious weakness, chest tightness and shortness of breath, discomfort in the precordial area, palpitations and sweating, loss of appetite, irritability, etc., red tongue with little coating, weak pulse or thin strings, the duration of the disease is more than three months, often in the acute phase of myocarditis or extended. The main points of identification are: weakness, palpitation, dizziness, without obvious heat toxicity symptoms.
2.Treatment plan
(1)Chinese herbal soup (benefitting Qi and nourishing Yin)
(2)Tongmu combining agent
(3)Shengvei injection in static drip
(4)Huangqi acupoint injection
(5) For those who feel heat toxicity again during the course of treatment, combine with heat toxicity evidence program.
Heart vein stasis type
1, symptom description: pale or dull face, discomfort or pain in the precordial area, palpitations and palpitations, chest tightness and shortness of breath, weakness and night sweating, purple and dull tongue or petechiae, thin white moss, thin pulse or knotted generation, most of the disease duration is more than half a year, often for the extension of myocarditis, if there is obvious heart enlargement and in line with the main symptoms, although the disease duration is less than half a year should also be considered this type. The main points of identification are: heart pain, or heart enlargement, and a long duration of illness.
2.Treatment plan
(1)Tongguo conglomerate or Chinese herbal soup
(2)Compound salvia powder injection 10mg/Kg/d
(3) With weakness, weakness and susceptibility, add Huangqi acupoint injection
(4) For those who feel heat toxicity again during the course of treatment, combine with heat toxicity program
Phlegm and gas obstruction type
1, symptom description: mainly wheezing atmosphere, may be accompanied by discomfort or pain in the precordial region, palpitations, weakness, etc., with thin white coating and string or thin pulse, often appearing after infectious diseases, often suspected of myocarditis. The main points of identification are: wheezing atmosphere is the main cause, and the duration of the disease varies.
2.Treatment plan
(1)Chinese herbal soup (broaden the chest and regulate the Qi)
(2)Tongguo Combination
(3)Use curcuma oil, perforated amber, astragalus injection, raw vein injection, compound salvia powder injection, etc. for static drip
(4) For those with weakness and susceptibility to physical weakness, add Astragalus acupoint injection
Heart Yang failure type
1, symptom description: pale or blue-gray face, tiredness and sleepiness, dizziness and palpitations, chest tightness and shortness of breath, wheezing and swelling, or cold and sweaty extremities, pale purple tongue, blue lips, sunken and thin pulse, or a weak desire to die. The duration of the disease is more than one year, often the chronic phase of myocarditis, but the acute phase of the fulminant cases can also be manifested in this type.
2.Treatment plan
Rescuing treatment according to the common scheme of Chinese and Western medicine