Department of General Internal Medicine, Osaka Medical College, Takatsuki, Japan.
Circ J. 2010 Oct;74(10):2193-9. doi: 10.1253/circj.cj-10-0452. Epub 2010 Aug 6.
An influenza pandemic occurred in 2009 and myocarditis associated with the 2009 influenza A (H1N1) pandemic was reported among hospitalized patients from August 2009.
The Japanese Circulation Society organized the Clinical Research Committee on Myocarditis Associated with Influenza Pandemic A (H1N1) 2009 and called for a case report on myocarditis for a national survey. The diagnosis of myocarditis was performed using the Guidelines for the Diagnosis and Treatment of Myocarditis (JCS 2009). Fifteen patients were reported to the committee. Fulminant myocarditis developed in 10 patients. Mechanical circulatory support (intra-aortic balloon pumping (IABP) and/or percutaneous cardiopulmonary support (PCPS)) was used on all 10 patients, 8 of whom were rescued. Abnormalities on echocardiography and elevated cardiac enzymes were seen in most of the patients. Myocarditis was found by endomyocardial biopsy in 6 patients. Three patients had complications with pneumonia.
In reality, myocarditis associated with pandemic influenza A (H1N1) seemed to be more common in hospitalized patients, compared with previous seasonal influenza virus outbreaks. To avoid misdiagnosis of acute myocarditis associated with influenza pandemic A (H1N1) 2009, it is essential to determine the characteristic symptoms, signs, and laboratory findings of acute myocarditis during influenza pandemics. Mechanical circulatory support (IABP and/or PCPS) was required to rescue patients with fulminant myocarditis.
2009 年发生了一次流感大流行，据报道，2009 年甲型 H1N1 流感大流行期间，住院患者中出现了心肌炎。
日本循环学会组织了与 2009 年甲型 H1N1 流感大流行相关的心肌炎临床研究委员会，并呼吁对心肌炎进行全国性病例报告调查。心肌炎的诊断采用《心肌炎诊断与治疗指南（JCS 2009）》。委员会收到了 15 例报告。10 例患者发展为暴发性心肌炎。所有 10 例患者均使用机械循环支持（主动脉内球囊泵（IABP）和/或经皮心肺支持（PCPS）），其中 8 例患者获救。大多数患者的超声心动图和心肌酶升高都存在异常。6 例患者通过心内膜心肌活检发现心肌炎。3 例患者并发肺炎。
实际上，与大流行流感 A（H1N1）相关的心肌炎在住院患者中似乎比以前的季节性流感病毒爆发更为常见。为避免误诊 2009 年甲型 H1N1 流感大流行引起的急性心肌炎，必须确定流感大流行期间急性心肌炎的特征性症状、体征和实验室发现。暴发性心肌炎患者需要机械循环支持（IABP 和/或 PCPS）来抢救。
