背景:急性心肌炎是一种常见病,病毒感染是北美和欧洲最常见的病因。然而,甲型心肌炎是罕见的。由于临床表现可能是暴发性的,早期识别和治疗至关重要,可能会阻碍血栓栓塞等并发症,从而影响整体预后.对文献进行简要回顾,诊断方式,工作和治疗进行了讨论。
方法:我们介绍一个42岁的案例,以前健康的女性最近有流感样症状,一周内发生失代偿性心力衰竭(HF)和心源性休克,因为甲型心肌炎.确定了双心室血栓。药物血流动力学支持,其次是HF治疗,允许心脏功能完全恢复。在与利伐沙班桥接的普通肝素下,腔内血栓消失。
结论:甲型流感引起的暴发性心肌炎非常罕见,据我们所知,与心内血栓形成无关。超声心动图是必不可少的一线成像方式。心脏磁共振在心肌炎的诊断中起着重要作用,并且在某些情况下可能会排除对心内膜活检的需要。可能需要进行冠状动脉造影以排除缺血性病因。暴发性疾病的一线治疗是药物治疗,如果需要,机械血流动力学支持。标准HF治疗完成了治疗选择,应尽快引入。并发症如心内血栓形成,需要有针对性的治疗。针对甲型流感的特定药物疗法在心肌炎中没有被证实的益处。
BACKGROUND: Acute myocarditis is a common condition, with viral infections being the most common aetiology in North America and Europe. Influenza A myocarditis is however rare. As clinical manifestation may be fulminant, early recognition and management are paramount and may impact overall prognosis by hindering complications such as thromboembolism. A brief review of the literature, diagnostic modalities, work-up and treatment are discussed.
METHODS: We present the
case of a 42-year-old, previously healthy woman with recent flu-like symptoms, developing decompensated heart failure (HF) and cardiogenic shock within a week, due to Influenza A myocarditis. Biventricular thrombi were identified. Pharmacological haemodynamic support, followed by HF therapy, allowed full recuperation of heart function. Intracavitary thrombi disappeared under unfractionated heparin with bridging to rivaroxaban.
CONCLUSIONS: Fulminant myocarditis due to Influenza A is rare and, to the best of our knowledge, has not been associated with intracardiac thrombi formation. Echocardiography is the essential first-line imaging modality. Cardiac magnetic resonance plays a major role in the diagnosis of myocarditis and may preclude the need for an endomyocardial biopsy in selected cases. Coronary angiography may be required to rule out ischaemic aetiology. First-line therapy in fulminant disease is pharmacological and, if required, mechanical haemodynamic support. Standard HF therapy complete the therapeutic options and should be introduced as soon as possible. Complications such as intracardiac thrombi formation, require targeted treatment. Specific drug therapies targeting Influenza A have no proven benefit in myocarditis.