Even if it is myocarditis caused by infection, not only viral infection, but also fungal parasites and bacteria can infect the myocardium. It's just that myocarditis caused by viruses is the most common in clinical practice. There is an old doctor's mantra of viral myocarditis.
The discussion of myocarditis by clinicians basically revolves around viral myocarditis, because nine out of ten patients are viral infections.
Dilated cardiomyopathy, like myocarditis, is caused by immune factors and virus infection. Among them, enterovirus and cytomegalovirus infection detected in myocardial biopsy have been confirmed to be directly related to dilated cardiomyopathy. Coincidentally, myocarditis also has the status of these two virus infections.
This is what Lee Seung-won and Dr. Dong are arguing about. Indeed, it is temporarily unclear whether this infection caused the two diseases to occur at the same time, or whether one disease occurred first and then gradually led to the emergence of the other disease.
What is the point of this debate? Because of the occult myocarditis that Xie Wanying just mentioned, clinicians failed to detect and check it in time, which eventually led to the death of heart failure patients.
Li Chengyuan denied her statement, thinking that the patient did not have occult myocarditis at all, but had dilated cardiomyopathy at the beginning, so it could not be detected clinically. The initial symptoms of dilated cardiomyopathy can be more subtle, the onset is slow, and the course of the disease can last for more than ten years until severe symptoms appear.
Dr. Dong agrees with Xie Wanying's point of view, which is equivalent to his belief that as long as it is a viral myocardial infection, there should be a process from myocarditis to dilated cardiomyopathy. The reason is that he has seen many such patients in clinic.
This is the difference between a physician and a surgeon. Patients with myocarditis generally do not go to the Department of Cardiothoracic Surgery, but first go to the Department of Cardiovascular Medicine for drug treatment. It is not until the patient has complete heart failure and considers heart transplantation that he will be transferred to surgery. Surgeons recognize only anatomical findings, myocarditis is deformation and necrosis of cardiomyocytes, and dilated cardiomyopathy is characterized by enlarged ventricles. How can it be the same
"Persistent myocarditis will lead to myocardial remodeling." Xie Wanying said.
"Yes. As she said, it's like this." Dr. Dong applauded her words by clapping her hands.
Li Chengyuan did not back down: "Your statement cannot 100% prove that dilated cardiomyopathy is from persistent myocarditis. It is possible that the two occur at the same time."
Xie Wanying suddenly thought of something when she heard her senior's words, and stopped talking.
Huang Zhilei and Xin Yanjun whispered: "The two of them are arguing, what is it about? You should suspect myocarditis now, right?"
Elevated troponin represents myocardial injury, and as one of the important indicators for auxiliary diagnosis of myocarditis, it has clinical guiding value. To diagnose myocarditis, patients need to have clinical symptoms related to myocarditis, such as chest pain, chest tightness, wheezing, heart failure, and palpitations. If the patient does not have obvious symptoms, other tests are needed to confirm whether it is myocarditis. Therefore, this patient is now at the initial stage of the doctor's suspicion of myocarditis. Next, the patient should be given an ECG and an echocardiogram as soon as possible.
If you want to ask the gold standard of myocarditis, it must be to do endomyocardial biopsy.
Since Xie Wanying auscultated the possibility of ventricular dilatation in the patient, at the suggestion of Dr. Li Chengyuan, dilated cardiomyopathy should be added to the suspected diagnosis.