一名患有急性心肌炎的儿童出现高度房室传导阻滞。
High-degree atrioventricular block in a child with acute myocarditis.
作者信息
Caughey Robert W, Humphrey John M, Thomas Patricia E
机构信息
Tulane University School of Medicine, New Orleans, LA.
Tulane University School of Medicine, New Orleans, LA ; Department of Pediatrics, Tulane University Medical Center, New Orleans, LA.
出版信息
Ochsner J. 2014 Summer;14(2):244-7.
BACKGROUND
Viral myocarditis is a common cause of transient electrocardiogram (EKG) abnormalities in children. The clinical presentation of acute myocarditis ranges from asymptomatic infection to fulminant heart failure and sudden death. Many children present with nonspecific symptoms such as dyspnea or vomiting, frequently leading to misdiagnosis. EKG abnormalities are a sensitive indicator of acute myocarditis and are present in more than 90% of cases.
CASE REPORT
A 13-year-old female suffered a syncopal episode and was found to have high-grade atrioventricular (AV) block caused by acute presumed viral myocarditis. With close monitoring, the EKG abnormalities resolved over the following 48 hours. In this case report, we discuss the incidence, pathogenesis, and outcomes of conduction disturbances in acute myocarditis.
CONCLUSION
High-degree AV block can occur in patients with acute myocarditis, and higher-degree AV block is correlated with greater myocardial injury. Additionally, severity of pathological changes may reflect the reversibility of AV block. In the majority of cases, however, this rhythm disturbance is transient and does not require permanent pacemaker placement.
背景
病毒性心肌炎是儿童短暂性心电图（EKG）异常的常见原因。急性心肌炎的临床表现从无症状感染到暴发性心力衰竭和猝死不等。许多儿童表现出如呼吸困难或呕吐等非特异性症状，常常导致误诊。心电图异常是急性心肌炎的敏感指标，超过90%的病例中会出现。
病例报告
一名13岁女性发生晕厥，被发现患有由急性推测性病毒性心肌炎引起的高度房室传导阻滞。经过密切监测，心电图异常在接下来的48小时内得到缓解。在本病例报告中，我们讨论了急性心肌炎传导障碍的发生率、发病机制和转归。
结论
急性心肌炎患者可发生高度房室传导阻滞，更高程度的房室传导阻滞与更严重的心肌损伤相关。此外，病理改变的严重程度可能反映房室传导阻滞的可逆性。然而，在大多数情况下，这种节律紊乱是短暂的，不需要植入永久性起搏器。
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