Clinical Analysis Of 30 Patients With Fulminant Myocarditis In Adults

Objective: The clinical characteristics and treatment strategies of adult fulminant myocarditis(FM)were investigated,for improving the clinical diagnosis and treatment level of FM,reducing the mortality.Methods: The clinical data of 30 adult FM patients who diagnosed in the First Affiliated Hospital of Guangxi Medical University from January 2011 to January 2020 were analyzed retrospectively,and the clinical manifestations,serological examination,electrocardiogram(ECG),imaging examination,treatment options and outcomes of adult FM were analyzed to investigate the clinical characteristics of adult FM.Results: 1.In this study,among 30 adult FM patients,the male-to-female ratio was 1:1.14,the average age was(32.93±10.38)years.97%(29/30)of the patients had the precursor symptoms of respiratory and/or digestive system.The clinical manifestations of the patients are various,with rapid onset of hemodynamic disturbances,leading to cardiogenic shock(70%)and systemic multiple organ failure(30%).2.The level of myocardial injury markers and cardiac insufficiency indicators were increased in all patients to varying degrees.White blood cell(WBC)and C-reactive protein(CRP)were increased in77%(23/30)and 80%(24/30)patients.3.All patients had abnormal ECG,including 83%(25/30)of low voltage in limb leads,43%(13/30)of sinus tachycardia,40%(12/30)of ventricular tachycardia/fibrillation,37%(11/30)of atrio-ventricular block(AVB),and 27%(8/30)of ST segment elevation.Chest imaging was completed in 29 patients,with exudative changes in both lungs(62%)and pleural effusion(55%)being common.Transthoracic echocardiography(TTE)was performed in 29 patients.Left ventricular posterior wall diameter(LVPWD)was thickened in 38%(11/30),interventricular septum diameter(IVSD)was thickened in 55%(16/30),Left ventricular end diastolic diameter(LVEDD)was increased in 45%(13/30),and left ventricular end systolic diameter(LVESD)was increased in 28%(8/30).Left ventricular ejection fraction(LVEF)was decreased in 55%(16/30),with a mean of(44.57±16.88)%(8.1-74%).In 55%(16/30)patients,the whole systolic motion of the wall was weakened,and in 17%(5/30)patients,the segmental wall motion was abnormal.Pericardial effusion was found in 38%(11/30).Only 10%(3/30)patients underwent coronary angiography(CAG),but there is no evidence of coronary ischemia was found.One patient(3%)underwent cardiac magnetic resonance(CMR).4.In terms of treatment,97%(29/30)patients were treated with glucocorticoid,70%(21/30)patients were treated with immunoglobulin,and 67%(20/30)patients were treated with both;all patients were treated with vasoactive drugs or inotropes ranging from 1 to 30 days.20%(6/30)patients were treated with Intra-aortic balloon pump(IABP),57%(17/30)with mechanical ventilation,20%(6/30)with continuous renal replacement therapy(CRRT)and 17%(5/30)with temporary pacemaker.5.43%(13/30)patients improved and discharged after active treatment,30%(10/30)patients died in hospital,23%(7/30)patients discharged automatically.6.The comparison of the main clinical data of 10 hospitalized deaths and 13 hospitalized survivors reveals that,the level of CK and CK-MB increased significantly,LVEF and LVEDD decreased significantly,LVPWD and IVSD thickened,the patients who used IABP and mechanical ventilation increased significantly in the hospitalized death group(P<0.05).Conclusion: 1.Adult FM is common in young and middle-aged patients,and patients often have related prodromal symptoms within 1 month of onset.It has a rapid onset,progression and high mortality.The clinical manifestations are various,always with rapid progression,severe heart failure,hemodynamic instability,cardiogenic shock,multiple organ failure and high mortality.2.TTE in adult FM patients is mainly characterized by slightly thickened interventricular septum,mostly unchanged ventricular chamber size,and ventricular systolic dysfunction.3.Adult FM patients should be actively treated with immunotherapy such as glucocorticoids and immunoglobulins.Mechanical circulatory support(MCS)should be given as early as possible to those who do not benefit from pharmacological correction of hemodynamic disturbances.