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Abstract: Viral myocarditis is a limited or diffuse inflammatory lesion of the myocardium caused by viral infections, especially coxsackie group B viruses. It is more common in children and adolescents. The general incidence is high in summer and low in winter. The patient in this case is a female, 23 years old, who developed palpitations, chest tightness and breath-holding after cold, and the symptoms worsened after activity. She was diagnosed as viral myocarditis after admission to the hospital and was a mild patient, and was discharged after medication and relief of symptoms and healing.
[Basic information] Female, 23 years old
Type of disease】Viral myocarditis
Hospital】The First Affiliated Hospital of Xi’an Jiaotong University
Time of consultation】July 2019
Treatment plan】Medication (recombinant human interferon alpha 2a for injection, thymidine for injection, hydrocortisone injection, dexamethasone acetate tablets)
Treatment period】7 days of inpatient treatment, 1 month of outpatient follow-up
Treatment effect】The patient was cured and discharged from the hospital.
I. Initial consultation
The patient, female, 23 years old, had palpitations, chest tightness and breath-holding after getting cold 6 days ago, and the symptoms were aggravated after activity, without fever, chest pain, cough and sputum. The above symptoms did not improve, so he came to our hospital for further treatment. Examination: no elevation in the precordial region, no tremor or pericardial friction, no enlargement of the cardiac turbinate, heart rate of 90 beats/min, rhythmical, heart sounds, no murmur in the auscultation area of each valve, no pericardial friction sound. The pulse rate was 90 beats/min, and the pulse rhythm was regular. There was no capillary pulsation sign and no femoral artery gunshot sound. The abdomen was flat and symmetrical, with no pressure pain or rebound pain, and no abdominal mass. The electrocardiogram was performed and the results showed ST-T segment changes and ventricular arrhythmias. CK-MB quantification was performed and the results: troponin I 0.5ng/ml, creatine kinase isoenzyme 12.9ng/ml and myoglobin 61.5ng/ml, all higher than normal. The preliminary diagnosis was viral myocarditis.
II. Treatment history
Generally, viral myocarditis is a self-limiting disease. According to the patient’s own condition, after communication with the patient, the patient was given antiviral treatment with recombinant human interferon alpha 2a for injection and thymidine for injection. In addition, to promote the propagation of virus and inflammation, hydrocortisone injection and dexamethasone acetate tablets were given to the patient. 1 week later, the patient’s symptoms improved and the injectable recombinant human interferon α2a, injectable thymidine, hydrocortisone injection and dexamethasone acetate tablets were discontinued.
III. Treatment effect
After treatment, the patient’s palpitations, chest tightness and breath-holding discomfort disappeared, her mental status was good, she slept and ate normally, and her bowel movements were normal. The results of electrocardiogram examination showed normal sinus rhythm. CK-MB quantification was performed, and the results showed that troponin I 0.2ng/ml, creatine kinase isoenzyme 4ng/ml and myoglobin 52ng/ml were within normal values. The patient was discharged from the hospital without any other symptoms.
IV. Notes
The patient was discharged from the hospital after her condition improved, and I was happy for the patient because her discomfort disappeared and she was in a happy mood when she was discharged. The patient should be discharged from the hospital with bed rest, gradually increase the amount of exercise, and try to avoid weight-bearing activities within one month of discharge. Daily attention should be given to a diet high in protein, rich in vitamins and easy to digest, especially supplemented with foods rich in vitamin C, such as fish, beef, spinach, apples, oranges, etc., to promote myocardial metabolism and repair. Pay attention to weather changes daily, keep warm and avoid colds.
V. Personal insight
When various factors lead to the decrease of body resistance, the virus directly invades the myocardium and causes myocardial cell lysis. Since the immune response is mainly T cells, cytokines, etc. mediated myocardial damage and microvascular damage, viral myocarditis can impair the function and structure of the heart. As in the patient in this case, the cold exposure led to a decrease in body resistance, which induced viral myocarditis and caused palpitations, suffocation and other cardiac discomfort symptoms. Therefore, special attention should be paid to keeping warm on a daily basis, avoiding long-term late nights and excessive stress that lead to a decrease in body resistance, which can reduce the incidence of viral myocarditis to some extent. In addition, daily attention should be paid to a balanced diet, while appropriate sports, such as walking, playing badminton, etc. to enhance the body’s resistance.