Imperial College Healthcare NHS Trust, London, UK
Imperial College Healthcare NHS Trust, London, UK.
Clin Med (Lond). 2021 Sep;21(5):e505-e510. doi: 10.7861/clinmed.2021-0121.
Acute myocarditis is a serious, likely underdiagnosed condition affecting people of all ages and for which the number of UK hospital admissions is rising. A primary diagnosis of myocarditis accounted for 0.04% (36.5 per 100,000) of all hospital admissions in England between 1998 and 2017, although this is likely to be an underestimate of the true burden of myocarditis. The aetiology is broad, including infective and inflammatory conditions as well as exposure to toxic agents. Clinical features are varied and overlap with other acute cardiac conditions making diagnosis a challenge. Cardiovascular magnetic resonance imaging currently serves as the gold standard non-invasive diagnostic modality. If an underlying aetiological process is identified, then therapy may be directed at the cause; however, for most, treatment is supportive and aimed at managing any complications such as heart failure or arrhythmias. There is emerging evidence for immunosuppressive therapy in certain cases. Prognosis is generally good with recovery in most; however, up to 30% with biopsy-proven myocarditis progress to develop a dilated cardiomyopathy and its potential associated complications. All-cause mortality in the UK for patients presenting to hospital with acute myocarditis is approximately 4%.
急性心肌炎是一种严重的、可能被低估的疾病,影响所有年龄段的人群,英国因该病住院的人数正在上升。1998 年至 2017 年期间,英格兰所有住院患者中,因心肌炎而住院的比例仅为 0.04%(每 10 万人中有 36.5 人),但这可能低估了心肌炎的真实负担。病因广泛,包括感染性和炎症性疾病以及接触有毒物质。临床表现多种多样,与其他急性心脏疾病有重叠,使诊断具有挑战性。心血管磁共振成像目前是黄金标准的无创诊断方式。如果确定了潜在的病因,则治疗可能针对病因;然而,对于大多数患者,治疗是支持性的,旨在治疗心力衰竭或心律失常等任何并发症。在某些情况下,免疫抑制疗法的证据正在出现。预后一般较好,大多数患者可恢复;然而,活检证实的心肌炎患者中有高达 30%会进展为扩张型心肌病及其潜在相关并发症。在英国,因急性心肌炎住院的患者的总死亡率约为 4%。