Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA.
Prog Cardiovasc Dis. 2010 Jan-Feb;52(4):274-88. doi: 10.1016/j.pcad.2009.11.006.
Myocarditis is an uncommon, potentially life-threatening disease that presents with a wide range of symptoms in children and adults. Viral infection is the most common cause of myocarditis in developed countries, but other etiologies include bacterial and protozoal infections, toxins, drug reactions, autoimmune diseases, giant cell myocarditis, and sarcoidosis. Acute injury leads to myocyte damage, which in turn activates the innate and humeral immune system, leading to severe inflammation. In most patients, the immune reaction is eventually down-regulated and the myocardium recovers. In select cases, however, persistent myocardial inflammation leads to ongoing myocyte damage and relentless symptomatic heart failure or even death. The diagnosis is usually made based on clinical presentation and noninvasive imaging findings. Most patients respond well to standard heart failure therapy, although in severe cases, mechanical circulatory support or heart transplantation is indicated. Prognosis in acute myocarditis is generally good except in patients with giant cell myocarditis. Persistent, chronic myocarditis usually has a progressive course but may respond to immunosuppression.
心肌炎是一种罕见的、潜在危及生命的疾病，可在儿童和成人中引起多种不同的症状。在发达国家，病毒感染是心肌炎最常见的病因，但其他病因包括细菌和原生动物感染、毒素、药物反应、自身免疫性疾病、巨细胞心肌炎和结节病。急性损伤导致心肌细胞损伤，进而激活先天和体液免疫系统，导致严重炎症。在大多数患者中，免疫反应最终会受到抑制，心肌恢复。然而，在某些情况下，持续的心肌炎症会导致持续的心肌细胞损伤和进行性症状性心力衰竭，甚至死亡。诊断通常基于临床表现和非侵入性成像发现。大多数患者对心力衰竭的标准治疗反应良好，尽管在严重情况下，可能需要机械循环支持或心脏移植。急性心肌炎的预后通常较好，除了巨细胞心肌炎患者。持续性、慢性心肌炎通常呈进行性发展，但可能对免疫抑制有反应。
