Myocarditis课件1.pptVIP

Epidemiology True cases of viral myocarditis are likely more common than currently diagnosed, largely because of its protean manifestations and reliance on myocardial biopsies for pathological confirmation. Epidemiology the precise incidence of myocarditis is difficult to ascertain. One estimate: about 8 to 10 per 100,000, However, because of failure to make the appropriate diagnosis or failure to detect subclinical cases, many deaths caused by myocarditis may go unrecognized. the prevalence of myocarditis among unselected autopsy series is as high as 1 to 5 per 100. When patients with only idiopathic dilated cardiomyopathy are considered, myocarditis accounts for 10 to 40 percent of the cases overall. This suggests that clinical myocarditis is not clinically suspected in a large number of cases, leading to deaths or severe heart failure. Etiology The inflamation of the myocardium caused by specific pathogen , including virus,bacteria,fungi,drug or chemical,et al . The most common causes today are infectious agents such as viruses or parasites or autoimmune conditions, especially by virus Viral myocarditis 病毒性心肌炎是指嗜心肌病毒感染引起的，以心肌非特异性间质炎症为主要病变的心肌炎。 Viral myocarditis(VMC)is presumed to be due to either an acute virus infection or a postviral autoimmune response. Etiology The most common etiological agent for viral myocarditis has traditionally been the enteroviruses, include the Coxsackie virus and echoviruses Pathology The pathogenesis of myocarditis is a classic paradigm of cardiac injury, followed by immunological response from the host as cardiac inflammation: 1)Evidence of myocyte necrosis; 2)the presence of inflammatory cells infiltrate . Myocardial involvement may be focal or diffuse; The pathological change is not specific for the etiologic diagnosis Mechanisms Virus infection 心肌组织中直接分离出病毒；在心肌组织上找到特异性病毒抗原。 2) Postviral autoimmune response 临床上在病毒感染后，经过一段潜伏期才出现心脏受累的征象，符合变态反应性疾患的规律；患者血