Diagnostic and Perinatal Management of Fetal Extrasystole

Fifty fetuses referred to the Polish Mother's Memorial Hospital for fetal echocardiography between January 1, 1991 and June 1, 1995 were evaluated. The mean fetal gestational age at the time of diagnosis of arrhythmia was 34.1 weeks, and the mean gestational age at the time of delivery was 38.7 weeks. Checkup echocardiographic examinations were performed every 10–14 days, for a mean 2.4 studies per fetus. In most cases (48/50, 96%), premature atrial contractions were present during the first echocardiography examination. The fetal heart study was normal in 30 cases; in 7 (14%) there was tricuspid valve regurgitation, in 7 (14%) an atrial septal aneurysm, in 4 congenital heart defects, in 1 myocardial hypertrophy, and in 1 disproportion in the four-chamber view. Of the 50 fetuses, 43 underwent regular echocardiographic monitoring alone; in 7 cases, based on the presence of additional echocardiographic findings, pharmacotherapy was applied (digoxin, verapamil, or both). Three neonates died after delivery owing to malformations in two cases (one critical aortic stenosis, one spina bifida plus hygroma colli) and due to myocarditis in one case. In six of seven newborns treated in utero, myocarditis was diagnosed after birth (including the one with neonatal demise). Most of the newborns were in good condition after birth, their mean Apgar score being 8.6 and the mean birth weight 3259 g. We concluded that most extrasystoles represent an isolated anomaly, not affecting the fetal condition. Their presence should not influence the obstetric care and may require only echocardiographic monitoring. In most of our cases the premature contractions subsided after birth, although sometimes they preceded fetal supraventricular tachycardia or appeared after congenital myocarditis.     

中西药物结合治疗病毒性心肌炎临床分析

目的:探讨中西药物治疗病毒性心肌炎(VMC)的疗效.方法:治疗组(60例)选用黄芪注射液、辅酶Q10和维生素C(VitC);对照组(43例)选用GIK极化液、辅酶Q10和VitC; 两组患者无禁忌症者给予一受体阻滞剂、钙拮抗剂和对症治疗后3个月动态心电图、超声心动图、肌酸激酶、肌钙蛋白T、柯萨奇病毒B IgM.结果:治疗组与对照组治疗后比较,心律失常减少(P<0.01),左室舒张末内径缩小(P<0.05),肌酸激酶明显下降(P<0 .01); 治疗组治疗前后比较,左室射血分数增加 (P<0.01).结论:采用中西药结合治疗V MC中临床疗效良好.     

小儿病毒性心肌炎与柯萨奇B组病毒抗体的关系探讨

目的探讨柯萨奇 Ｂ组病毒抗体ＩｇＭ测定在心肌炎病原学诊断和临床诊断中的意义。方法１９９６～１９９８年儿科住院病人７０例,分为心肌炎组２０例,疑似心肌炎组２５例,对照组２５例。用间接酶联免疫吸附法（ＥＬＩＳＡ）测定柯萨奇Ｂ组病毒抗体ＩｇＭ和ＩｇＧ。结果柯萨奇Ｂ组病毒抗体ＩｇＭ阳性心肌炎组１１例（５５％）,疑似心肌炎组１１例（４４％）,对照组１１例（４４％）,经统计学处理,其差别无显著性意义。结论用ＥＬＩＳＡ法测定柯萨奇Ｂ组病毒抗体ＩｇＭ,阳性提示有柯萨奇Ｂ组病毒感染,对心肌炎患儿可以作出病因和病原学诊断,但不能以此作为临床诊断心肌炎的依据。     

参白注射液对病毒性心肌炎模型大鼠α-MHC基因表达的影响

目的:探讨参白注射液调节病毒性心肌炎心肌肌凝蛋白重链α-MHC基因表达的作用机制.方法:无菌分离、切取新生1～3天Wistar大鼠的心室肌,制备和培养心肌细胞,建立病毒性心肌炎(VMC)感染模型--体外培养大鼠心肌细胞感染柯萨奇B3(CVB3)病毒,通过免疫组化实验,检测参白注射液对α-MHC基因表达的影响.结果:正常组α-MHC基因表达可见明显阳性信号,病毒感染组蛋白阳性信号表达减少,病毒感染加参白注射液组能明显上调α-MHC基因的表达含量.结论:参白注射液通过减轻自身免疫损伤,使具有ATP酶活性的MHC表型发生变化的几率减少,从而上调α-MHC的表达,进而增强心肌收缩力.     

L-NAME对实验性自身免疫性心肌炎的保护作用

目的观察NG-硝基-L-精氨酸甲酯(L-NAME)对实验性自身免疫性心肌炎(EAM)Lewis大鼠模型的治疗效果,并探索可能的治疗机理。方法 20只Lewis大鼠建立EAM动物模型:双足底注射心肌C蛋白片段和完全弗氏辅佐剂的油状混合物,腹腔注射百日咳毒素。大鼠随机等分为治疗组和模型对照组,每组各10只。治疗组腹腔注射5 mg·kg-1·d-1L-NAME,从免疫注射术后第1天开始连续20 d,1次/d。对照组相同时间内给予相同剂量生理盐水腹腔注射。治疗结束后第1天处死动物,心脏取材,进行系列检测。其中组织病理学石蜡切片苏木素-伊红(HE)染色检测心肌炎症分级,免疫组织化学染色检测T淋巴细胞浸润,天狼星红染色检测心肌胶原纤维含量,硝酸还原酶法检测NO水平,明胶酶谱法检测胶原酶活性。结果与对照组比较,L-NAME治疗组心肌炎症级别下降[(3.42±0.31)vs(2.51±0.22),P<0.01]、T淋巴细胞浸润数目减少[(28.2±4.6)vs(13.2±1.9),P<0.01]、心肌间质纤维化级别下降[(2.33±0.26)vs(1.14±0.17),P<0.01]、血清NO水平降低[(68.34±8.61)μmol/L vs(45.71±6.53)μmol/L,P<0.01],明胶酶活性降低[(254 526±4 729)vs(184 712±3 869),P<0.01]。结论 L-NAME抑制EAM病理发展过程,其机制可能与通过降低NO水平和明胶酶活性,从而降低心肌炎症细胞浸润,延缓心肌间质纤维化有关。     

黄芪对柯萨奇B_3病毒性心肌炎小鼠单核细胞趋化蛋白-1表达的影响

目的:探讨黄芪对柯萨奇B3(CVB3)病毒性心肌炎小鼠单核细胞趋化蛋白-1(MCP-1)表达的影响。方法:55只BALB/c小鼠,雄性,周龄为6-8周,随机分成3组:A组为空白对照组(15只);B组为病毒对照组(20只);C组为黄芪治疗组(20只)。于接种病毒第14天处死所有存活小鼠,取心脏,分别用光镜检查心肌组织的病理变化,用免疫组化方法和逆转录-聚合酶链反应(RT-PCR)检测心肌组织中MCP-1的表达。结果:①黄芪治疗组生存率较病毒对照组提高(P<0.05);②病毒对照组与空白对照组相比心肌组织中可见大量的MCP-1的表达,且于心肌的病变面积成正比(P<0.01,r=0.87);③黄芪治疗组心肌病理积分和MCP-1的表达明显低于病毒对照组(P<0.01)。结论:黄芪可以减少病毒性心肌炎心肌组织MCP-1的产生可能是其治疗病毒性心肌炎的机制之一。     

Viral myocarditis and coagulopathy: increased tissue factor expression and plasma thrombogenicity

We investigated the effects of viral infection on Tissue Factor (TF) expression and activity in mice within the myocardium to understand increased thrombosis during myocarditis. Mice were infected with coxsackie virus B3 (CVB3) and the hearts were collected at day 4, 8 and 28 post infection (p.i.). Myocardial TF expression and cellular activity as well as plasma activity were analyzed from CVB3 infected mice by Western blot, chromogenic Factor Xa generation assay, in situ staining for active TF and immunohistochemistry. In addition to TF expression, hemodynamic parameters were measured during the time course of infection. Furthermore, we analyzed myocardial tissues from patients with suspected inflammatory cardiomyopathy. TF protein expression was maximally 5-fold elevated 8 days p.i. in mice and remained increased on day 28 p.i. (P < 0.001 vs. non-infected controls). Alterations in TF expression were associated with fibrin deposits within the myocardium. The TF pathway inhibitor protein expression in the myocardium was not altered during myocarditis. Active cellular TF co-localized with CD3 positive cells and VCAM-1 positive endothelial cells in the myocardium. The TF expression was positively correlated with the amount of infiltrating CD3 and Mac3 positive cells (Spearman-Rho ρ = 0.749 P < 0.0001 for CD3⁺ and ρ = 0.775 P < 0.0001 for Mac3⁺; N = 35). Increased myocardial TF expression was associated with a 2-fold elevated plasma activity (P < 0.05 vs. non-infected controls). In the human hearts, the TF expression correlated postively with an endothelial cell activation marker (ρ = 0.523 P < 0.0001 for CD62E; N = 54). Viral myocarditis is a hypercoagulative state which is associated with increased myocardial TF expression and activity. Upregulation of TF contributes to a systemic activation of the coagulation cascade.     

自身免疫性心肌炎的治疗进展

心肌炎是引起儿童及青少年猝死最常见的病因之一,自身免疫反应在其发生发展中起重要作用。组织病理学证实心肌炎是由T细胞介导的免疫反应,主要表现为严重的心肌损害和炎细胞浸润。研究者从不同的角度发掘治疗自身免疫性心肌炎的方法,包括免疫调节,干扰传导通路、细胞因子等,该文就自身免疫性心肌炎治疗进展进行综述。     

Manifestaciones cardiovasculares en pacientes hospitalizados con dengue

IntroductionCardiac complications in dengue patients are not uncommon and are not diagnosed, since they are usually mild and self-limiting.ObjectivesTo characterize the cardiovascular manifestations in hospitalized patients with dengue infection.MethodsWe conducted an observational, analytical, longitudinal, prospective epidemiological study, which included 427 patients treated at Manuel Fajardo Clinical-Surgical Teaching Hospital with diagnosis of dengue infection since April 2017 to April 2018.ResultsCardiovascular manifestations (19.7%), mainly heart rate disorders (sinus bradycardia [13.8%], atrial [4.9%] and ventricular [4.0%] extrasystoles) were frequent in dengue infection patients. Pericarditis and myocarditis were diagnosed in 1.6% and 0.2% respectively. These disorders were self-limiting in 83.3% of cases and occurred in the first days of the onset of fever in 75.0%. Advanced age (OR = 1.70), male sex (OR = 1.94), decreased platelet count (OR = 1.13) and dengue with warning signs (OR = 3.29) were related to a higher probability of presenting cardiovascular disorders in the course of a dengue infection.ConclusionsCardiovascular manifestations in dengue patients are frequent, and are related to advanced age, male sex, as well as severe forms of the disease.