Even if myocarditis is caused by infection, it is not limited to viral infection. Fungi, parasites, and bacteria can all infect the myocardium. However, myocarditis caused by viruses is the most common in clinical practice, and there is a catchphrase among old doctors: viral myocarditis.
When clinicians discuss myocarditis, it basically revolves around viral myocarditis, because nine out of ten patients are infected with the virus.
Like myocarditis, dilated cardiomyopathy is caused by immune factors and viral infection. Among them, enterovirus and cytomegalovirus infection detected in myocardial biopsy have been confirmed to be directly related to dilated cardiomyopathy. Coincidentally, myocarditis also has these two viral infections.
This is the point of contention between Dr. Li Chengyuan and Dr. Dong. Indeed, it is not yet certain whether this infection caused both diseases to occur at the same time, or whether one disease occurred first and then gradually led to the appearance of the other disease.
What is the significance of this debate? It is because the latent myocarditis mentioned by Xie Wanying just now was not discovered and examined in time by clinicians, which eventually led to the death of patients with heart failure.
Li Chengyuan denied her statement, believing that the patient did not have latent myocarditis at all, but had dilated cardiomyopathy at the beginning, so it could not be detected clinically. The initial symptoms of dilated cardiomyopathy can be more subtle, with a slow onset, and the course of the disease can take more than ten years to develop serious symptoms.
Doctor Dong tends to agree with Xie Wanying's point of view, which is equivalent to his belief that as long as it is a viral myocardial infection, there should be a process from myocarditis to dilated cardiomyopathy. The reason is that he has seen many such patients in clinical practice.
This is the difference between an internist and a surgeon. Patients with myocarditis usually do not go to the cardiothoracic surgery department, but first go to the cardiovascular department for drug treatment. Only when the patient has complete heart failure and is considering a heart transplant will they be transferred to the surgery department for surgery. Surgeons only recognize anatomical results. Myocarditis is the deformation and necrosis of myocardial cells, and dilated cardiomyopathy is characterized by ventricular enlargement. How can they be the same?
"Persistent myocarditis can lead to myocardial remodeling," said Xie Wanying.
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"Yes. Just as she said, that's it." Dr. Dong clapped his hands in approval of her words.
Li Chengyuan did not give in: "Your statement cannot 100% prove that dilated cardiomyopathy comes from persistent myocarditis. It is possible that the two occurred at the same time."
Xie Wanying suddenly thought of something while listening to her senior's words and stopped talking.
Huang Zhilei and Xin Yanjun whispered, "What are they arguing about? Shouldn't we suspect myocarditis now?"
Elevated troponin indicates myocardial damage. As one of the important indicators for auxiliary diagnosis of myocarditis, it has clinical guidance value. To diagnose myocarditis, the patient needs to have clinical symptoms related to myocarditis, such as chest pain, chest tightness, shortness of breath, heart failure, palpitations, etc. If the patient does not have obvious symptoms, other tests are needed to confirm whether it is myocarditis. Therefore, this patient is now in the initial stage where the doctor suspects whether it is myocarditis. Next, the patient should be given an electrocardiogram and echocardiogram as soon as possible.
If you ask about the gold standard for myocarditis, it must be an endomyocardial biopsy.
Since Xie Wanying detected the possibility of ventricular dilatation during auscultation, Dr. Li Chengyuan suggested that the diagnosis should be supplemented with dilated cardiomyopathy.
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