Araújo J A, Campelo A L, Maia C M, Rocha M G, de Almeida A P, Barros R B, Cirino C M
Serviço de Cardiologia do Hospital de Messejana, INAMPS, Fortaleza, CE.
Arq Bras Cardiol. 1990 Feb;54(2):117-20.
In the current study we analyzed clinical evolution and therapeutic aspects of malignant diphtheric myocarditis.
Fourteen patients with primary diagnosis of diphtheria were prospectively evaluated. Cardiac involvement was detected after 11.5 (mean) days. The diagnosis of diphtheric myocarditis was done in clinical basis.
Seven (50%) patients died. Cardiac failure was a common finding in all cases. Complete A-V block was identified in eight (57%) patients. Temporary pacemaker was implanted in 10 cases, six of them died due to myocardial failure. Definitive pacemaker was necessary in two patients with persistent complete A-V block after one-month follow-up. One patient with atrial fibrillation died with sepsis. Respiratory infection was the commonest extracardiac complication (six cases) and two patients developed Guillain-Barré syndrome. We also identified neurologic, renal and adrenal complications.
Cardiac rhythm disturbances in diphtheric myocarditis are associated with high probability of necessity of temporary pacemaker and high mortality. Definitive pacemaker can be implanted in persistent complete A-V block.
在本研究中，我们分析了恶性白喉性心肌炎的临床演变及治疗情况。
对14例初诊为白喉的患者进行前瞻性评估。平均在11.5天后检测到心脏受累情况。白喉性心肌炎的诊断基于临床。
7例（50%）患者死亡。心力衰竭在所有病例中均常见。8例（57%）患者出现完全性房室传导阻滞。10例患者植入了临时起搏器，其中6例因心肌衰竭死亡。1例房颤患者死于败血症。呼吸道感染是最常见的心外并发症（6例），2例患者出现格林-巴利综合征。我们还发现了神经、肾脏和肾上腺并发症。
白喉性心肌炎的心律失常与临时起搏器植入的高必要性及高死亡率相关。对于持续性完全性房室传导阻滞患者可植入永久性起搏器。
