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Abstract: Viral myocarditis often starts after a viral infection of the respiratory and digestive systems, and is characterized by pain in the precordial region, palpitations, chest tightness, and chest pain. The patient in this case developed paroxysmal precordial pain after a cold 1 month ago, and was diagnosed with this disease after admission to the hospital. After treatment with vitamin C injection, inosine injection, acyclovir tablets and metoprolol tartrate capsules, the condition improved and the discomfort disappeared.
Basic information】Female, 26 years old
Type of disease】Viral myocarditis
Hospital】The First Hospital of China Medical University
Time of consultation】October 2016
Treatment plan】Medication (vitamin C injection, inosine injection, acyclovir tablets, metoprolol tartrate capsules)
【Treatment period】3 weeks of hospitalization
【Treatment effect】The condition improved and the discomfort disappeared
I. Initial consultation
The patient, female, 26 years old, developed paroxysmal precordial pain after a cold 1 month ago, no chest tightness, breath-holding, no radiating pain in the left upper limb, no sweating, no wishing membrane, no fever, no cough, coughing sputum, and took traditional Chinese medicine (specific details not available) at home for 3 days, with no significant improvement in symptoms. He came to our hospital for further treatment. The results of outpatient cardiac enzyme examination showed that creatine kinase 224.0 U/L, lactate dehydrogenase 426.8 U/L, creatine kinase isoenzyme 88.6 U/L, alpha-hydroxybutyrate dehydrogenase 283.9 U/L, all of which were higher than the normal range, and was initially diagnosed as viral myocarditis and admitted to hospital. Since the onset of the disease, the patient had a clear consciousness, a clear spirit, a normal diet and sleep, and normal urine and stool.
Treatment history
The patient’s electrocardiogram was completed on the day of admission, and the results indicated sinus arrhythmia. Combined with the patient’s complaint of paroxysmal precordial pain one month ago, the patient was judged to be in the acute stage of viral myocarditis, which can be aggravated by activity due to the rapid progress of the disease. The patient was given vitamin C injection and inosine injection intravenously to improve myocardial nutrition and promote myocardial metabolism. Patients were instructed to take acyclovir tablets for antiviral treatment. The patient was also instructed to take metoprolol tartrate capsules to improve heart function and control heart rate. After 3 weeks of treatment, the patient was discharged with improved symptoms and stable condition.
III. Treatment effect
After drug treatment, the patient’s symptoms of paroxysmal precordial pain gradually improved to disappear. The ECG examination was repeated, and the results showed sinus rhythm. The results of cardiac enzyme examination showed that the indexes of creatine kinase, lactate dehydrogenase, creatine kinase isoenzyme and α-hydroxybutyrate dehydrogenase decreased to normal range. During the treatment period, the patient had no other discomfort. The patient had good mental status, good sleep and no other special discomfort, and was discharged from the hospital.
IV. Notes
After the patient’s condition improved, while I was happy for the patient, I did not forget to advise the patient that the following points should be noted in life after discharge.
1. The patient’s diet should be light and easy to digest, choosing fresh vegetables and fruits rich in vitamins, as well as foods rich in high quality protein such as milk, fish and chicken, while paying attention to avoiding the intake of foods high in salt, fat and sugar, which can help to take care of the heart.
2. Patients should avoid recommending strenuous exercise and heavy physical labor for 6 months after discharge, rest more and avoid strain.
3. Patients should pay attention to keep warm, increase and decrease clothing according to temperature changes in a timely manner, and prevent the occurrence of colds, which can reduce the risk of myocarditis induced by viral infections.
V. Personal insights
Usually viral myocarditis is preceded by the onset of a cold, fever, sore throat, diarrhea and other manifestations of viral infection, followed by symptoms such as pain in the precordial region, palpitations, chest tightness, chest pain, weakness, dyspnea, etc. Once similar symptoms are detected, one should be alert to the occurrence of viral myocarditis and go to the hospital as soon as possible so as not to delay the development of the treatment condition into chronic myocarditis. The patient in this article had viral myocarditis induced after a cold, but because of the timely admission to the hospital, he recovered well after treatment and did not lead to more serious consequences.