臨床病理討論會(huì)ppt課件(參考版)
2025-01-08 04:24本頁(yè)面
【正文】 Extracorporeal membrane oxygenation (ECMO) Bright side of the myocarditis VAD and ECMO in fulminant myocarditis: ? Basically a reversible disease ? Indications: Failing medical treatment ( inotropic requirement with poor perfusion) Cardiac arrest Bright side of the myocarditis Oute of VAD and ECMO used in fulminant myocarditis: J Thorac Cardiovasc Surg. 2022。343:138898 Dark side of the myocarditis Complexity of pathogenesis Factors contributing to host susceptibility ? Autoantibodies: to adenosine nucleotide translocator, myosin ? Expression of cell adhesion molecules (ICAM1) ? Expression of coxsackieadenovirus receptor (CAR) Dark side of the myocarditis Often refractory to conventional treatment ? Standard therapy: ACE inhibitor, inotropic agents, diuretics – often not effective in fulminant myocarditis ? Immunosuppression: IVIG, steroids, cyclosporin– still controversial Bright side of the myocarditis Good long term prognosis of fulminant myocarditis Improvement of mechanical support: LVAD, BVAD, ECMO Bright side of the myocarditis Good long term prognosis of fulminant myocarditis NEJM 2022。s disease Other Sarcoidosis Kawasaki disease Cornstarch NONINFECTIOUS ETIOLOGIES Dark side of the myocarditis Etiology hard to find Pediatr Cardiol 2022。les poor peripheral perfusion Cardiovascular promise Diagnostic approach Flulike illness, arrhythmia, cardiovascular promise Acute myocarditis highly suspected D/D: Dilated cardiomyopathy Anomalous left coronary artery Chronic tachyarrhythmia Pericarditis Diagnostic approach EKG: ? VPC bigeminy, ventricular tachycardia ? STsegment change Elevated cardiac enzyme Echocardiogram: marked LV dyskinesia Endomyocardial biopsy ? Lymphocyte infiltration ? Myocyte degeneration Acute myocarditis confirmed Clinical classification of myocarditis Fulminant Acute Chronic active Chronic persistent Initial presentation Shock, severe LV dysfuntion CHF CHF Normal LV function Endomyocardial biopsy Multifocal active myocarditis Active or borderline myocarditis Active or borderline myocarditis
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