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    Even if it is myocarditis caused by infection, not only viral infection, but also fungi, parasites and bacteria can infect the myocardium.  It¡¯s just that myocarditis caused by viruses is the most common in clinical practice. There is an old doctor¡¯s mantra of viral myocarditis.

    Clinicians¡¯ discussion of myocarditis basically revolves around viral myocarditis, because nine out of ten patients are infected by viruses.

    Dilated cardiomyopathy, like myocarditis, is caused by immune factors and viral infection.  Among them, enterovirus and cytomegalovirus infections detected in myocardial biopsy have been confirmed to be directly related to dilated cardiomyopathy.  Coincidentally, myocarditis is also caused by these two viral infections.

    This is the point of contention between Li Chengyuan and Dr. Dong.  Indeed, it is currently unclear whether this infection caused the occurrence of two diseases at the same time, or whether one disease occurred first and then gradually led to the emergence of the other disease.

    What is the significance of this debate?  Because of the latent myocarditis mentioned by Xie Wanying just now, clinicians failed to detect and perform examinations in time, which eventually led to the death of heart failure patients.

    Li Chengyuan denied her statement and believed that the patient did not have latent myocarditis at all. He had dilated cardiomyopathy at the beginning, so it could not be diagnosed clinically.  The initial symptoms of dilated cardiomyopathy can be more subtle, with a slow onset, and the course of the disease can last for more than ten years until severe symptoms appear.

    Dr. Dong agrees with Xie Wanying's point of view, which means that he believes that as long as it is a viral myocardial infection, there should be a process from myocarditis to dilated cardiomyopathy.  The reason is that he has seen many such patients in clinical practice.

    This is the difference between a physician and a surgeon.  Patients with myocarditis generally do not go to cardiothoracic surgery and first go to cardiovascular medicine for drug treatment.  It is necessary to wait until the patient has completely suffered from heart failure and is considering a heart transplant before he is transferred to the surgery department for surgery.  Surgeons recognized only anatomical findings; myocarditis is deformation and necrosis of myocardial cells, and dilated cardiomyopathy is characterized by ventricular enlargement.  How can it be the same?

    "Persistent myocarditis will lead to myocardial remodeling." Xie Wanying said.

    "Yes. As she said, that's it." Dr. Dong clapped his hands and applauded her words.

    Li Chengyuan did not back down: "Your statement cannot 100% prove that dilated cardiomyopathy comes from persistent myocarditis. It is possible that both occur at the same time."

    Xie Wanying suddenly thought of something when she heard what her senior said and stopped talking.

    Huang Zhilei and Xin Yanjun whispered: "The two of them were quarreling, what exactly were they quarreling about? Now we should suspect it is myocarditis, right?"

    Elevated troponin represents myocardial damage. As one of the important indicators to assist in the diagnosis of myocarditis, it has clinical guiding value.  To diagnose myocarditis, the patient needs to have clinical symptoms related to myocarditis, such as chest pain, chest tightness, breathlessness, heart failure, and palpitations.  If the patient does not have obvious symptoms, other examinations are needed to confirm whether it is myocarditis.  Therefore, this patient is now in the initial stages of myocarditis that doctors are questioning.  Next, the patient should undergo an electrocardiogram and echocardiogram as soon as possible.

    If you want to ask about the gold standard for myocarditis, it must be endocardial myocardial tissue biopsy.

    Since Xie Wanying¡¯s auscultation revealed the possibility of ventricular dilation in the patient, Dr. Li Chengyuan suggested that dilated cardiomyopathy should be added to the suspected diagnosis.

    Purple Pen Literature (remember the website address: www.hlnovel.com
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