Hjartadrep eða bráð hjartabilun án kransæða- eða lokusjúkdóms : bólga í hjartavöðva

Abstract

In 1985 and 1986 seven patients (6 men, 1 woman; mean age 28.8 years) were admitted to the City Hospital in Reykjavik (Borgarspitalinn) with probable myocarditis. The most serious acute complications occurred in two young men after participating in active sport. One of them arrested while playing soccer and could not be resuscitated. Autopsy revealed enlarged heart, no significant coronary artery disease, and histology consistent with myocarditis. The other patient developed acute pulmonary edema shortly after playing and arrested as well after admission. After resuscitation it was obvious he had sustained embolic stroke and left hemiparesis. Cardiac and neurologic function improved markedly over the next few months and cardiac catheterization showed no coronary artery disease. The third patient, 27 years old man, who previously had normal exercise tolerance was admitted in congestive heart failure. Gallium scan showed increased uptake suggestive of inflammation of the heart. He had frequent ventricular arrhythmias and needed amiodarone treatment as well as therapy for congestive heart failure. He died two years later. Autopsy revealed cardiomegaly, myocardial fibrosis but no coronary artery disease consistent with healed myocarditis. In two other patients no coronary artery disease was seen but one of them had severely reduced myocardial function with ejection fraction of only 20%. This patient was the only one of these seven who did not have elevated cardiac isoenzymes but he had been ill for a week before admission. Two of the patients recovered completely and had no complications or further evidence of cardiac disease. An effort was made to confirm likely viral etiology in these patients but was successfully done in only one of them.

Innlagnir á sjúkrahús af völdum bráðabólgu í hjartavöðva eru fremur fátíðar. Árin 1985-86 lögðust óvenju margir sjúklingar inn á Borgarspítalann sem taldir voru hafa þennan sjúkdóm eða sjö talsins. Um var að ræða sex karla og eina konu. Sjúklingarnir voru á aldrinum 20-56 ára við greiningu en flestir á þrítugsaldri, meðalaldur 28,8 ár (tafla I). Fimm þeirra fengu alvarlega fylgikvilla og tveir hafa látist. Sagt verður nánar frá þessum sjúklingum hér á eftir. Greining sjúkdómsins er erfið og byggist fyrst og fremst á einkennum. Hefðbundnar rannsóknaraðferðir eru til nokkurrar hjálpar svo sem hjartalínurit, röntgenmynd og hjartahvatar. Hvatarnir eru þó aðeins hækkaðir í takmarkaðan tíma og því stundum orðnir eðlilegir þegar sjúklingurinn kemur til skoðunar. Sértækari rannsóknaraðferðir hafa einnig komið til sögunnar svo sem sýnitaka úr hjartavöðva eins og vikið verður að (1¬3). Meðferð er fyrst og fremst fólgin í að draga úr einkennum. Einnig hefur verið reynt að hafa áhrif á gang sjúkdómsins og draga úr bólgusvörun með barksterum og/eða ónæmisbælandi lyfjum (4).