36-year-old man admitted to ICU after catching a cold! Doctor: Be careful! Fulminant myocarditis

Mr. Chen, 36, would never have thought that he would be threatened with a fatal cold, and would be on the verge of death and be admitted to the intensive care unit.

Mr. Chen, 36 years old, caught a cold due to the sudden drop in temperature recently. He had a high fever of 39.5 degrees Celsius and developed symptoms such as fatigue, nasal congestion, runny nose, sore throat, and muscle aches. At first, he thought it was just an ordinary fever and cold, so he only took cold medicine and antipyretics.

After two days, the symptoms did not improve, and he also developed palpitations and chest tightness. He took antiviral drugs on his own, and the fever symptoms were slightly relieved. Due to the busy work at the end of the year, he insisted on going to work. Unexpectedly, on January 8, Mr. Chen suddenly fainted at work, and his colleagues urgently called 120 and sent him to the emergency department of Hunan Second People's Hospital (Provincial Brain Hospital) for treatment .

After the emergency department of Hunan Provincial Second People's Hospital (Provincial Brain Hospital) received the patient, they immediately conducted tests such as myocardial enzymes, troponin, BNP, and electrocardiogram, and found that Mr. Chen was not suffering from a simple cold. The results of myocardial enzymes, troponin, and electrocardiogram shocked the doctors. The normal troponin level of a normal person is less than 0.1ng/ml, while Mr. Chen's test results showed that it had reached 10.717ng/ml, more than 100 times higher than the normal value, which means that his myocardium was severely damaged; his blood pressure continued to drop, and he had already developed life-threatening conditions such as cardiogenic shock; the electrocardiogram diagnosed him with sinus tachycardia with third-degree atrioventricular block, and the electrocardiogram showed that his heart had an 8-second cardiac arrest.

Based on his medical history, the doctor initially diagnosed Mr. Chen with fulminant myocarditis. Considering that the inflammation caused heart conduction block, leading to cardiac arrest and fainting, his condition was critical and he needed to immediately place a temporary pacemaker to help his heart work.

If there are critical conditions such as cardiogenic shock, severe arrhythmia, and dyspnea, it is necessary to promptly apply extracorporeal devices such as intra-aortic balloon pump (IABP) and extracorporeal membrane oxygenation (ECMO) to help him survive the acute stage of myocarditis. So after coronary angiography ruled out myocardial infarction, he was immediately transferred to the cardiac intensive care unit for observation and treatment.

1. What is fulminant myocarditis?

According to Li He, deputy chief physician of the Department of Cardiovascular Medicine at Hunan Provincial Second People's Hospital (Provincial Brain Hospital) , fulminant myocarditis is an acute diffuse inflammatory myocardial disease, manifested by rapidly onset hemodynamic disorders, acute heart failure and even sudden death. It is characterized by rapid onset, extremely rapid progression of the disease and extremely high risk of death.

2. Etiology and Pathogenesis

The pathogenesis of fulminant myocarditis is complex and may involve the interaction of multiple factors such as the patient's genetic background, the body's immune status, viral virulence, and the environment. It is currently believed that the inflammatory storm is an important cause of the rapid onset, rapid progression, severe condition, and high mortality of fulminant myocarditis.

Viral infection is the most common cause of the disease, among which coxsackie virus, influenza virus, adenovirus, etc. are common pathogenic viruses. These viruses directly cause myocardial cell damage and necrosis through blood circulation or direct contact with myocardial cells.

On the other hand, after viral infection, the human immune system will initiate an immune response to eliminate the virus. During this process, immune cells may accidentally injure myocardial cells and cause immune myocardial damage.

In certain cases, the body's innate immune response is overactivated, resulting in the release of a large number of inflammatory factors, forming an inflammatory storm (also known as a cytokine storm), which is the main mechanism leading to severe myocardial damage and pump failure.

Non-infectious factors such as allergies (food or drug allergies), autoimmune system diseases and drug toxicity may also induce myocarditis, but viral infection is still the main cause. The body's immune response may be too strong, causing a large number of myocardial cell damage and necrosis.

3. Clinical symptoms

The prodromal symptoms of fulminant myocarditis are relatively subtle and often similar to those of a cold, such as fever, fatigue, nasal congestion, runny nose, sore throat, cough, muscle aches, etc. However, as the disease progresses, patients will experience a series of symptoms related to impaired heart function, such as palpitations, chest tightness, dyspnea, dizziness, fatigue, pale complexion, and syncope.

In addition, some patients may also experience critical conditions such as severe arrhythmias and cardiogenic shock. The clinical symptoms of fulminant myocarditis are atypical and can be easily ignored or misdiagnosed. When patients develop obvious cardiac symptoms, their condition is often already very serious and the best time for treatment has been missed, leading to an increased mortality rate.

The high mortality rate of fulminant myocarditis is mainly due to the following reasons:

1. Sudden onset and rapid progression of the disease

Fulminant myocarditis usually develops rapidly in a short period of time, and patients may develop severe cardiac dysfunction within a few hours to a few days, such as heart failure, cardiogenic shock and other life-threatening conditions. Because the disease progresses too quickly, it is often too late to provide effective treatment, resulting in a high mortality rate.

2. Severe damage to heart function

The disease causes a large number of myocardial cells to degenerate and die after being invaded by the virus, making the heart unable to pump blood effectively and causing heart failure. Heart failure can cause patients to experience severe symptoms such as dyspnea and edema, seriously affecting the blood supply to various organs of the body, leading to multiple organ failure and increasing the risk of death.

3. Prone to serious complications

(1) Arrhythmia: Myocardial inflammatory response may lead to abnormalities in the cardiac conduction system, causing rapid or irregular heartbeats, such as ventricular tachycardia, which in turn affects blood circulation, aggravates the condition, and even causes cardiac arrest.

(2) Heart rupture: Acute myocarditis may cause myocardial fiber rupture. If not treated promptly, it may lead to damage to the heart structure or even heart rupture, which is life-threatening.

(3) Inflammatory storm: Its pathogenesis involves excessive activation of the heart's innate immunity and the formation of an inflammatory storm. The dysregulated immune response causes a positive feedback loop between innate immune cells and non-immune cells and cytokines, and causes excessive release of cytokines, leading to cardiac damage. This is also an important reason for its rapid onset, rapid progression, severe condition, and high mortality rate.

4. Difficulty in early diagnosis

The clinical symptoms of fulminant myocarditis are atypical and often similar to those of a cold, such as fever, fatigue, nasal congestion, runny nose, sore throat, cough, etc., which are easily ignored or misdiagnosed. When patients have obvious cardiac symptoms, their condition is often very serious and the best time for treatment has been missed, resulting in an increased mortality rate.

5. Difficulty in treatment

Although there are currently treatment methods such as "comprehensive treatment plans based on life support", the treatment effect is still not ideal for some critically ill patients, especially those who have already developed multiple organ failure, and the mortality rate is still high. In addition, some patients may be insensitive to certain therapeutic drugs or have other underlying diseases, which increases the difficulty and risk of treatment.

4. How to prevent and manage yourself

The key to preventing fulminant myocarditis is to improve the body's immunity and avoid viral infection. Specifically, you can start from the following aspects:

1. Maintain good living habits

Arrange work and rest time reasonably, avoid overwork, and ensure adequate sleep; maintain reasonable eating habits, a low-salt, low-fat, high-fiber diet, and increase the intake of vitamins and proteins; exercise appropriately to improve the body's immunity; pay attention to keep warm when the weather changes.

2. Pay attention to personal hygiene

Wash your hands frequently, open windows regularly to ventilate the room, and keep air circulating indoors; practice separate dining and avoid sharing tableware with others to reduce the chance of virus transmission.

3. Avoid contact with sources of infection

During the peak period of the virus, try to avoid going to crowded and confined spaces, and wear a mask correctly and in a timely manner.

4. Get vaccinated on time

Get flu shots, pneumonia shots and other vaccines in a timely manner according to your doctor's advice to prevent viral infections.

5. Maintain a positive attitude

Avoid excessive anxiety and tension so as not to affect your physical and mental health.

Deputy Chief Physician Li He reminded that fulminant myocarditis is a heart disease with an acute onset, rapid progression, and extremely high early mortality rate. Once it occurs, it is often life-threatening. The key to the treatment of fulminant myocarditis lies in early identification, rapid intervention, and comprehensive treatment. Once diagnosed, life support treatment should be given immediately, including strict bed rest, nutritional support, antiviral treatment, immunotherapy, etc.

We need to remain highly vigilant about this disease and reduce its harm by raising awareness, strengthening prevention, timely medical treatment and reasonable treatment. Let us work together to protect heart health and stay away from the threat of fulminant myocarditis.

Hunan Medical Chat Special Author: Zhang Haiyan, Department of Cardiology, Hunan Second People's Hospital (Provincial Brain Hospital)

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(Edited by YT)