Müller S
Z Gesamte Inn Med. 1979 Nov 1;34(21):640-8.
On the basis of newer knowledge from literature in a survey aspects of symptomatology, diagnostics and course of the myocarditis important for practice are represented. According to the frequency of the virus myocarditis is referred to the importance of immunopathogenetic factors for prognosis and course. Own experiences confirm the transition from an acute myocarditis into a chronic cardiomyopathy which was observed by various investigators. In a 17-year-old female patient the development of a congestive cardiomyopathy after acute myocarditis could be pursued for several years. After-examination of 58 patients after acute myocarditis resulted after 3 years in 62% in cardiac residual symptoms, in which cases anamnestic data and objective findings of the examination well correlated. In 14 patients (24.1%) chronic recidivating courses were found. The importance of the biopsy of the endomyocardium for the diagnostics and differential diagnostics of cardiomyopathies is represented at the instance of a 20-year-old male with subacute rheumatic myocarditis who was hospitalised on account of symptoms of a left heart insufficiency, enlargement of the heart and a picture of a left hypertrophy in the ECG. Bioptically was found a hypertrophy with formation of a large nucleus. After 1 1/2 years clinical improvement and normalisation of size of the heart and ECG. The control biopsy now resulted in normal findings of the heart.
基于文献中关于心肌炎症状学、诊断及病程方面的最新知识,阐述了对实践具有重要意义的内容。根据病毒感染频率,心肌炎与免疫发病机制因素对预后及病程的重要性相关。自身经验证实了从急性心肌炎转变为慢性心肌病这一情况,多位研究者也观察到了这一点。在一名17岁女性患者中,急性心肌炎后充血性心肌病的发展情况得以追踪数年。对58例急性心肌炎患者进行3年后复查,结果显示62%存在心脏残留症状,在这些病例中,既往病史数据与检查的客观结果相关性良好。在14例患者(24.1%)中发现有慢性复发病程。以内膜心肌活检对心肌病进行诊断及鉴别诊断的重要性,通过一名20岁患有亚急性风湿性心肌炎的男性患者得以体现,该患者因左心功能不全症状、心脏扩大及心电图显示左心室肥厚图像而入院。活检发现有肥大并形成大核。1年半后临床症状改善,心脏大小及心电图恢复正常。此时的对照活检显示心脏结果正常。