Clinical Manifestations of and Laboratory Tests for Myocarditis and Fulminant Myocarditis

Abstract

Fulminant myocarditis is the most severe and special type of myocarditis, most patients with fulminant myocarditis have some some prodromal of pathogen infection and within few days have severe fatigue, poor appetite and may have a little diarrhea, chest comfort, chest pain or dizziness due to hypotension. Vital signs usually change, including hypotension or shock and fast heart rate, and heart sound markedly reduced and often hear third sound gallop. ECG usually has marked change such as low voltage and widened QRS wave and arrhythmias. Cardiac troponin I or T and NT-proBNP significantly elevated, which suggest acute myocardial injury. Timely cardiac echo can find diffuse hypokinesia of the heart LVEF reduce and change fast. Tests of level of plasma inflammatory factors is greatly helpful for diagnosis of fulminant myocarditis, especially soluble ST2 level elevation (>55ng/mL). What need to exclude in most is acute myocardial infarction (by coronary angiography), and next is stress cardiomyopathy. Timely clinical diagnosis is important for saving life. Endomyocardial biopsy and MRI should be performed for clear diagnosis. The key is “early identification, early diagnosis, early prediction and early treatment”.