Clinical features of the fulminant myocarditis

Objective To review the clinical features of fulminant myocartitis, in order to provide assistance to the clinical management. Methods The clinic data of 183 patients with viral myocarditis, including 153 cases of acute myocarditis and 30 cases of fulminant myocarditis admitted in our hospital during January 2008 and Dec 2012 were retrospectively analyzed. The age of onset, interval after virus infect, initial symptoms, auxiliary examination, treatment, and turnover were compared in the study. Results The average onset age of fulminant myocartitis and acute myocarditis were similar[(22.3±7.6) vs. (26.2±12.6) years, P=0.105 5]. There was a significant difference between the two gourps in the rate of patients with a explicit history of virus infection[30.0%(9/30) vs. 78.4%(120/153), χ2=28.3, P<0.001], the average interval after virus infect [(3.1±2.2) vs. (7.0±3.80) d, P<0.001] and the length of hospital stay[(12.1±6.9) vs. (6.9±4.50) d, P<0.001].Chest congestion (101/153, 66.0%), feebleness(76/153, 49.7%), fluster(74/153, 48.4%) are the most onset symptoms of acute myocarditis, while chest congestion (24/30, 80.0%), shortness of breath(14/30, 46.7%), feebleness(13/30, 43.3%) in flunimant myocarditis.Advanced A-V block(19/30, 63.3%), cardiogenic shock (18/30, 60.0%), ventricular arrhythmia(16/30, 53.3%), Adams-Stokes syndrome(8/30, 26.67%) and acute renal failure(8/30, 26.7%) were the most complications of flunimant myocarditis.Temporary pacemaker(11 cases), extracorporeal memberane exygenator(7 cases) and intra-aortic balloon pump(7 cases) were applied in critical patients.In acute phase, 21 cases were cured, 9 cases was dead of cardiogenic shock and ventricular(27, 30.0%). Two dead cases applied with ECMO because of delay.After leaving hospital, 1 case was implanted permanent pacemaker, 2 cases became chronic myocarditis and required hospitalization repeatedly. Conclusions The fulminant myocarditis has a rapid onset, most of which has no prodrome of virus infection or a shorter interval than acute myocarditis. Timely and effective mechanical circulatory support is critical for fulminant myocarditis. Key words: Myocarditis; Clinical feature; Diagnosis