Maisch Bernhard, Ruppert Volker, Pankuweit Sabine
Medical Faculty of Philipps University Marburg and Cardiovascular Center Marburg, Erlenring 19, 35037, Marburg, Germany,
Curr Heart Fail Rep. 2014 Jun;11(2):166-77. doi: 10.1007/s11897-014-0196-6.
Fulminant myocarditis is a clinical syndrome with signs of acute heart failure, cardiogenic shock, or life-threating rhythm disturbances in the context of suspected myocarditis. It is not an etiological diagnosis, but may have different underlying causes and pathogenetic processes - viral, bacterial, toxic, and autoreactive. Clinical management of the disease entity at the acute stage involves hemodynamic monitoring in an intensive care unit or similar setting. Rapid routine work-up is mandatory with serial EKGs, echocardiography, cardiac MRI, heart catheterization with endomyocardial biopsy for histology, immunohistology, and molecular analysis for the underlying infection and pathogenesis. Heart failure therapy is warranted in all cases according to current guidelines. For fulminant autoreactive myocarditis, immunosuppressive treatment is beneficial; for viral myocarditis, IVIg can resolve the inflammation, reduce the viral load, and even eradicate the microbial agent. ECMO, IABP, ventricular assist devices, LifeVest, or ICD implantation can bridge to recovery or to heart transplantation.
暴发性心肌炎是一种临床综合征，在疑似心肌炎的情况下出现急性心力衰竭、心源性休克或危及生命的心律失常体征。它不是病因诊断，可能有不同的潜在病因和发病机制——病毒、细菌、毒性和自身反应性。该疾病实体急性期的临床管理包括在重症监护病房或类似环境中进行血流动力学监测。必须进行快速常规检查，包括系列心电图、超声心动图、心脏磁共振成像、心内膜心肌活检的心脏导管检查，用于组织学、免疫组织学以及对潜在感染和发病机制的分子分析。根据当前指南，所有病例均需进行心力衰竭治疗。对于暴发性自身反应性心肌炎，免疫抑制治疗有益；对于病毒性心肌炎，静脉注射免疫球蛋白可减轻炎症、降低病毒载量，甚至根除病原体。体外膜肺氧合（ECMO）、主动脉内球囊反搏（IABP）、心室辅助装置、LifeVest或植入式心脏复律除颤器（ICD）可帮助患者恢复或过渡到心脏移植。
