Feeling anxious and short of breath after having “Yang” should alert you to viral myocarditis!

Recently, many people in the outpatient clinic have experienced chest tightness, palpitations, and shortness of breath, and asked what are the symptoms of viral myocarditis? How to identify it early?

Panic and shortness of breath after "Yang"

Beware of viral myocarditis!

patient:

Doctor, why does my heart beat so fast and my heart rate increase after I was infected with the new coronavirus?

doctor:

In addition to feeling anxious, do you have any other discomfort?

patient:

I feel a bit of chest tightness, get easily fatigued at work, and feel a bit dizzy.

doctor:

OK, now I suggest you to have an electrocardiogram, cardiac ultrasound and myocardial enzyme spectrum to check if you have myocarditis.

1. What is myocarditis?

Myocarditis refers to heart dysfunction caused by myocardial damage due to various infectious and non-infectious factors. Clinically, myocarditis is mostly caused by viral infection and can be seen in any age group, with young and middle-aged people being the most common.

2. What are the clinical manifestations of viral myocarditis?

Early myocarditis is non-specific and may manifest as chest tightness, chest pain, shortness of breath, fatigue, nausea and vomiting, dizziness, etc., which are difficult to distinguish.

Mild viral myocarditis may manifest as arrhythmia, patients often feel their heartbeats speed up or slow down, and the electrocardiogram may show myocardial ischemia.

Severe viral myocarditis is characterized by acute onset, severe condition and high mortality rate.

3. What are the ultrasound manifestations of viral myocarditis?

For early viral myocarditis, myocardial enzyme spectrum and electrocardiogram can be manifested earlier. For patients with more serious conditions, echocardiography can be more intuitive, showing cardiac cavity enlargement, myocardial hypertrophy and edema, abnormal heart function, and other valvular dysfunction, pericardial effusion, etc. It plays a good auxiliary diagnosis role in judging the degree of cardiac function damage caused by viral myocarditis, and can dynamically observe the treatment effect and prognosis.

4. How to prevent viral myocarditis?

Sometimes a minor cold can also cause myocarditis. Therefore, when you have a cold or other physical discomfort, pay attention to rest, get enough sleep, and avoid staying up late and other behaviors that harm your body. Pay attention to nutritional balance in your diet and eat appropriate amounts of fruit. In cold weather, pay attention to keeping warm and avoid catching a cold. Physical exercise should also be done step by step, and don't force it.

5. How does Traditional Chinese Medicine understand and treat viral myocarditis?

From the perspective of etiology of traditional Chinese medicine, the main cause of viral myocarditis is exogenous wind-heat or rheumatism. The former is more common in winter and spring, and the latter is more common in summer and autumn. Wind-heat invades the lung defense and easily damages the qi and yin of the lung. Since the lung qi runs through the heart meridian, and all meridians are directed to the lung, when the qi and yin of the lung are insufficient, it is bound to lead to the deficiency of the heart, forming a disease of both heart and lung deficiency. Rheumatism invades the spleen, and the disease starts from the spleen, which easily damages the qi and yang of the spleen. Since the heart governs blood and the spleen is the source of qi and blood biochemical transformation, when the spleen yang is insufficient, it will directly affect the deficiency of heart yang, and the phenomenon of heart and spleen disease will occur. Viral myocarditis with arrhythmia as the main manifestation mostly belongs to the category of "heart palpitations, pulse knots and irregular pulses" in traditional Chinese medicine. Due to insufficient righteousness, evil toxins invade the heart, consume qi and damage yin, and the heart loses its nourishment. It is placed in the pulse, causing the pulsation to lose its normal degree, resulting in palpitations and restlessness, and irregular pulse.

1. Viral myocarditis - Yangxin Drink

(Composition) Adenophora 6g, Ophiopogon japonicus 10g, Schisandra chinensis 6g, Polygonatum odoratum 20g, Salvia miltiorrhiza 6g, Scrophularia ningpoensis 6g, Juncus effusus 1.5g, Bambusa obtusifolia 3g, Panax notoginseng powder 1.5g (taken with water), Licorice root 10-30g.

(Usage) Decoction in water (dosage for children aged 6 years old).

(Effects and indications) Replenishes qi and yin, dissipates blood stasis and restores pulse. Used for viral myocarditis.

(Explanation of the prescription) This prescription is made by adding flavor to Shengmai San, and ginseng is replaced with Adenophora to enhance the function of nourishing yin and promoting body fluid. Shengmai San in the prescription nourishes qi and yin, and uses Polygonatum odoratum to nourish the heart qi, which plays a role in nourishing the myocardium; Licorice is sweet and mild, and has the effect of relieving pain and treating palpitations. Modern pharmacological research shows that licorice has adrenal cortex hormone-like effects; Panax notoginseng and Salvia miltiorrhiza have the functions of promoting blood circulation and removing blood stasis, and promoting blood circulation, which can slow down the heart rate, reduce the oxygen consumption of the myocardium, and achieve the effect of protecting the myocardium; Scrophularia ningpoensis nourishes yin and disperses nodules, and benefits the heart qi; Bamboo leaves and Juncus effusus enter the heart meridian, and have the functions of clearing away evil heat, promoting urination, and making evil heat go out through urination, and reducing the disadvantages of using a large amount of licorice to retain water.

(Addition and subtraction) For those with exterior symptoms in the early stage, add Yinqiao Powder; for those with sore throat, add honeysuckle, forsythia, and burdock fruit; for those with low fever, add Rehmannia root and Pleurotus eryngii; for those with palpitations and insomnia, add Ziziphus jujuba and Platycladus orientalis; for those with chest tightness and chest pain, add Trichosanthes kirilowii and Allium macrostemon; for those with excessive sweating, add oyster and floating wheat; for those with yang qi about to be lost, add Shenfu Decoction.

In the early stage of the disease, it is advisable to eliminate evil and strengthen the body, and take into account the Ying and Wei. Use Yinqiao Powder combined with Yangxin Drink to clear away heat, detoxify, penetrate the surface, nourish Yin, remove blood stasis and restore the pulse. In the recovery period of myocarditis, it is advisable to support the body's positive energy, nourish Yin, remove blood stasis and restore the pulse. Take Yangxin Drink as the main prescription, and be flexible and add or subtract according to symptoms. For the sequelae of myocarditis, it is advisable to promote Qi and Yang, nourish Yin and nourish blood. Use Yangxin Drink combined with Zhigancao Decoction for treatment.

2. Viral myocarditis - Yiqi Yangyin Fumai prescription

(Composition) Stir-fried Codonopsis pilosula 15g, raw Astragalus membranaceus 15g, Ophiopogon japonicus 12g, Schisandra chinensis 9g, Polygonatum sibiricum 15g, Adenophora australis 15g, Salvia miltiorrhiza 18g, Sophora flavescens 15g, Dendrobium candidum 30g, Taraxacum mongolicum 30g, Poria 15g, Licorice root 9g.

(Effects and indications) Replenishing Qi, nourishing Yin and restoring pulse. Used for arrhythmias caused by viral myocarditis.

(Addition and subtraction) To relieve chest tightness and depression, add Radix Curcumae, Fructus Trichosanthis, Radix Dalbergiae, Radix Bupleuri, Rhizoma Cyperi, and Rhizoma Chuanlianzi; to promote blood circulation, increase the dosage of Radix Salviae Miltiorrhizae, which Dr. Gu often uses up to 30g, or add Rhizoma Chuanxiong; to calm the mind, add dragon teeth and magnetite; to clear the throat and relieve the exterior, add Radix Scrophulariae, Radix Belamcandae, Radix Platycodonis, Radix Trichosanthis, Radix Sterculiae, and Radix Peucedanum; to strengthen the spleen and promote digestion, add Rhizoma Dioscoreae, Fructus Amomi, Rhizoma Atractylodis Macrocephalae, Rhizoma Gastrodiae, and Rhizoma Leonuri; to warm the kidney and tonify the kidney, add Rhizoma Cinnamomi, Radix Rehmanniae, Fructus Ligustri Lucidi, Fructus Corni, and Herba Leonuri; to promote yang, add Radix Allii Macrostemonis and Rhizoma Cinnamomi; to clear deficiency heat, add Radix Digupi and Polygonatum; to treat constipation, add Rhizoma Cannabis and Rhizoma Polygalae. In clinical practice, Dr. Gu often combines disease differentiation with modern Chinese medicine pharmacology research, adds Ephedra, Fructus Aconiti Lateralis, and Asarum to treat conduction block, and increases the dosage of Radix Sophorae Flavescentis to treat frequent premature ventricular contractions.

3. Viral myocarditis and its sequelae - Zhengmai Yin

(Composition) Raw Rehmannia glutinosa 15-30g, cinnamon twig 6-12g, Ophiopogon japonicus 15g, roasted liquorice root 6-9g, Salvia miltiorrhiza 15g, Astragalus 15g, Isatis indigotica 15g, Sophora flavescens 12g, Camellia sinensis root 15g.

(Usage) Decoction in water.

(Effects and indications) Nourishes the heart yin, helps the heart qi, clears away evil toxins, and regulates the heart pulse. It is mainly used to treat arrhythmias caused by viral myocarditis and its sequelae. Common symptoms include chest tightness, palpitations, and pulse cessation.

(Explanation of the prescription) The prescription contains 4 ingredients: Radix Rehmanniae, Cinnamon Twig, Radix Ophiopogonis, and Radix Licorice. The prescription is based on the idea of ​​Radix Licorice Soup, and 2 ingredients, Radix Astragali and Radix Salviae Miltiorrhizae, are added as the main ingredients to strengthen the body. Among them, Radix Rehmanniae, Radix Ophiopogonis, and Radix Salviae Miltiorrhizae, replenish yin and blood to nourish the heart body; Cassia Twig, Radix Astragali, and Radix Licoricee, help the heart qi to restore the heart function. If the heart qi is sufficient, the pulse qi can be unblocked, and if the heart blood is sufficient, the pulse body can be sustained. Folium Isatidis, Radix Sophorae Flavescentis, and Camellia Sinensis Root are selected from the perspective of disease diagnosis. Folium Isatidis and Radix Sophorae Flavescentis are intended to remove evil toxins or eliminate primary lesions to facilitate the recovery of myocardial function. At the same time, Radix Sophorae Flavescentis and Camellia Sinensis Root are matched, which has a strong effect of correcting heart rhythm. Camellia Sinensis Root can also strengthen the heart and can be used regardless of the speed of the heart rate. The whole prescription has both replenishment and unblocking, taking care of both qi and blood, strengthening the body without leaving evil, and removing evil without hurting the body. When used together, the evil toxins are cleared, the body qi is invigorated, and the blood is restored.

(Addition and subtraction) If the evil toxin is severe and the throat pain is obvious, add 15g of dandelion and 12g of ground clove. If there is chest tightness or dull chest pain, add 9g of curcuma and 9g of scutellaria. In the recovery period or sequelae period of this disease, the symptoms are mainly qi and yin depletion. Remove the isatis leaf and tea tree root, add 30g of Pseudostellaria baicalensis, 6g of Schisandra chinensis, and 15g of raw lily. If the symptoms of yin deficiency are not obvious but the symptoms of qi deficiency are prominent, such as pale and fat tongue, or tooth marks on the edges, no throat pain, etc., remove the isatis leaf, add Codonopsis pilosula 15g, and the dosage of cinnamon twig can also be heavier.