Typhoid myocarditis

Introduction to typhoid myocarditis Severe typhoid fever can be complicated by typhoidmyocarditis. The endotoxin of typhoid bacillus is the result of myocardial injury. Strictly speaking, it should be called toxic myocarditis. The typical natural course of typhoid fever is about 4 weeks, which can be divided into 4 stages, with high fever, gastrointestinal symptoms, nervous system symptoms, hepatosplenomegaly, rash and other symptoms. Typhoid-type myocarditis often occurs in the extreme stage of typhoid fever (ie, onset). After 1 week, lasting 2 to 3 weeks), generally typhoid fever often has a relatively slow pulse (the pulse speed is not proportional to the increase in body temperature) or severe veins. If the patient is not obvious, the symptoms should be alert to the presence of typhoid myocarditis. basic knowledge The proportion of sickness: 0.01% Susceptible people: no special people Mode of infection: non-infectious Complications: arrhythmia typhoid myocarditis congestive heart failure atrioventricular block

Causes of typhoid myocarditis

(1) Causes of the disease

Typhoid fever is an acute intestinal infectious disease caused by typhoid bacillus. Typhoid fever is a systemic disease. It is not limited to intestinal damage. It can cause intestinal perforation, intestinal bleeding, toxic hepatitis, bronchitis and pneumonia, acute gallbladder. Inflammation, hemolytic uremic syndrome, hemolytic anemia, etc., of which toxic myocarditis is one of its complications.

(two) pathogenesis

Myocardial damage caused by endotoxin from Salmonella typhi.

Typhoid myocarditis prevention

1. Manage the source of infection and cut off the route of transmission of typhoid fever.

2. Improve the immunity of the population.

3. In the course of typhoid fever, pay attention to the observation of the condition, early detection of <typhoid myocarditis (electrocardiogram showing low voltage arrhythmia, conduction block, ST segment and T wave changes, etc., children often manifest as tachycardia), once found strictly bedridden Plus glucocorticoids, high doses of vitamin C, vitamin B1, FDP (fructose 1,6-diphosphate) and other treatments.

Typhoid myocarditis complications Complications arrhythmia typhoid myocarditis congestive heart failure atrioventricular block

The disease often has complications such as arrhythmia, heart failure, sudden cardiac death, and severe cases can be life-threatening.

1. Arrhythmia typhoid myocarditis can appear accelerated heart rate, pre-systolic and other manifestations, EC cycle can show prolongation of PR interval, ST segment shift and T wave changes.

2. Heart failure Severe acute myocarditis due to a wide range of myocardial infection, myocardial damage is serious, heart enlargement, congestive heart failure and so on.

3. Cardiac sudden death typhoid myocarditis with complete atrioventricular block may be the cause of sudden cardiac death.

Symptoms of typhoid myocarditis Common symptoms Heart sputum short toxemia chest tightness heart sounds low blunt slow pulse high fever accompanied by abdominal pain, ... hepatosplenomegaly tachycardia

1. Typical performance of typhoid fever The typical natural course of typhoid fever is about 4 weeks, which can be divided into 4 stages, with high fever, gastrointestinal symptoms, nervous system symptoms, hepatosplenomegaly, rash and other symptoms, while typhoid myocarditis often occurs. In the extreme stage of typhoid fever (that is, after 1 week of onset, lasting 2 to 3 weeks), general typhoid fever often has a relatively slow pulse (the pulse speed is not proportional to the increase in body temperature) or severe veins, such as when the patient is relatively insignificant. The presence of typhoid myocarditis.

2. The clinical manifestations of typhoid myocarditis are more common in patients with severe typhoid fever, which may be accompanied by severe toxemia symptoms. Patients may have low heart sounds and tachycardia (typical typhoid fever should be relative slow pulse), galloping, can be Pre-contraction, patients can complain of heart palpitations, chest tightness and shortness of breath, heart dullness can be slightly enlarged, blood pressure is reduced, but severe cardiac insufficiency is rare, and can even cause typhoid bacillus endocarditis.

Typhoid myocarditis

1. General inspection

(1) The total number of white blood cells is often reduced, (3 ~ 5) × 109 / L, the classification count see neutropenia with nuclear left shift, lymph, monocytes relatively increased; eosinophils decreased or disappeared.

(2) Urine routine: There may be mild proteinuria, and occasionally a few casts may be seen.

(3) routine: in the case of intestinal bleeding, there may be occult blood or bloody stools.

2. Bacterial culture

The pathogen examination of typhoid bacillus is the basis for the diagnosis of typhoid fever. The samples can be taken from blood, bone marrow, urine, stool and rose rash.

3. Typhoid serum agglutination test was positive.

4. Enzyme-linked immunosorbent assay

It can detect various antibodies against Salmonella typhi.

5. ECG

Common sinus tachycardia, prolonged PR interval, ST-T changes and other myocardial damage manifestations, premature contraction is not uncommon, occasionally ventricular tachycardia can occur, 1987 sputum medical school reported a case of typhoid myocarditis Concomitant QT interval prolonged polymorphic ventricular tachycardia (torsional ventricular tachycardia), sudden cardiac arrest, cured after rescue.

6. Echocardiography

It can be found that the wall motion is weakened and the left ventricular function is damaged, and occasionally there is pericardial effusion.

Diagnosis and diagnosis of typhoid myocarditis

diagnosis

Typhoid myocarditis should be considered in the cardiovascular manifestations of typhoid patients.

Differential diagnosis

Rheumatic myocarditis

Rheumatic myocarditis often has a history of streptococcal infection such as tonsillitis or angina, anti-"O" increase, blood sedimentation increased significantly, C-reactive protein (CRP)-positive, ECG changes are more common in the PR interval, throat swab There are often streptococcus growth in the culture, and there are many arthritis. In view of rheumatoid myocarditis, there is often endocarditis. Therefore, mitral regurgitation systolic murmur is more obvious, and due to valve edema, inflammation has diastolic murmur. (Carey Coombs murmur), if the heart is not enlarged, and the noise is louder, rheumatism is more likely. Although typhoid myocarditis has myocarditis, there are many typical typhoid symptoms, no diastolic murmur, and ECG. There may be ST-T changes, prolonged PR interval and T wave changes, etc. The total number of white blood cells is low, and typhoid bacillus is cultured from blood, bone marrow, feces, urine or rose rash scraping liquid, and attention is made from the above points.

2. -receptor hyperfunction syndrome

Intrinsic is more common in young women, often with certain mental factors as incentives, complaints are more variable, and objective signs are less, no fever, elevated erythrocyte sedimentation rate and other evidence of inflammation, mainly manifested as ST segment of ECG, T wave changes and sinus tachycardia Speed, oral propranolol 20 ~ 30mg after half an hour can make ST segment, T wave changes back to normal; typhoid myocarditis on the electrocardiogram ST-T changes caused by myocardial damage, oral propranolol can not be recovered in a short time Normal, in addition, beta-receptor hyperfunction syndrome has no evidence of cardiac enlargement, cardiac dysfunction and other structural heart disease.

3. Primary cardiomyopathy

There may be a family history, a long course of disease, slow progress, the heart of dilated cardiomyopathy is often enlarged, there may be arterial embolism, the virus is negative, the serum virus neutralizing antibody titer is not increased in a short period of time, and the electrocardiogram often has various arrhythmias. Sometimes pathological Q waves can be seen. Typhoid myocarditis often occurs in the second to third weeks of typhoid fever. At the same time, it is accompanied by severe toxemia. The symptoms, signs and electrocardiogram changes of typhoid myocarditis generally return to normal as the condition improves.

4. Coronary heart disease

This disease and myocarditis can affect the heart muscle, causing the heart to expand, can have arrhythmia, heart failure, etc., coronary heart disease is more common in men over 45 years old and postmenopausal women, older people are more common, coronary heart disease often There are a variety of disease factors, such as hyperlipidemia, hypertension, diabetes, obesity, family history, etc., while typhoid cardiomyopathy is more common in adolescents and children, often with typical symptoms and signs of typhoid fever, bacterial culture found Salmonella typhimurium can be used to identify the disease.

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