Overview: diphtheria is caused by the corynebacterium diphtheriae acute respiratory infection disease, the clinical to the pharyngeal tonsillitis and (or) laryngitis, throat typical white pseudomembrane formation and toxin caused symptoms of poisoning as the main features can be combined severe myocarditis, known as diphtheria myocarditis, Department of diphtheria the most serious The complications and the leading cause of death.[Cause]
diphtheria myocarditis is caused by what of?
disease caused by the diphtheria bacillus of acute infectious diseases, with patients or carriers of the Department exposure and infection, often limited to upper respiratory tract, the formation of tenacious pseudomembrane, firmly attached to their organization under the force ripped the bleeding. Pseudomembrane began to appear on one side of the pharyngeal tonsil area, severe cases can be extended to the other side of the tonsils and uvula, soft palate, pharyngeal wall and extends to the larynx, trachea, bronchi caused by bronchial obstruction, and finally death hypoxia. diphtheria can also be manifested as skin type, and occasionally against the eye, ear, buccal mucosa, genitalia, often secondary. Systemic effects mainly myocarditis, peripheral neuritis, outside the Department of diphtheria toxin.
(B) the pathogenesis
diphtheria bacillus attacks the weak, only the damage of the skin and mucous membrane local growth and reproduction. However, an exotoxin produced by highly toxic, absorbed by the body can produce sera symptoms and lead to systemic pathological changes in myocardium, adrenal gland, and peripheral nerve as a. diphtheria myocarditis mainly involving myocardial cells and cardiac conduction system, the early pathological changes seen significant expansion of the heart, myocardial cells showed cloudy swelling and fatty degeneration, followed by the emergence of multiple focal hyaline degeneration, granular degeneration, and myocardial necrosis, near accompanied by polymorphonuclear leukocyte infiltration; late may have connective tissue hyperplasia, cardiac conduction system degeneration, necrosis and scar formation, resulting in conduction system dysfunction.
diphtheria exotoxin can cause heart and cardiac conduction system leading to degeneration, necrosis and scar formation, diphtheria disease is common in the first week and 2 weeks at the beginning. 2 can be turned back to change the weekend, including granulation tissue formation, restore myocardial disease, collagen tissue and fibroblasts. To the course of the first 3, 4 weeks of myocardial scar tissue formation may have.[Sign]
diphtheria What are the early symptoms of myocarditis?
the disease more common in children, winter and spring for multiple seasons. Mainly transmitted by droplets, but also by the toys, clothes and appliances indirect communication. The following clinical features:
1. diphtheria signs include fever, nausea, vomiting, in the pharynx, larynx, nose, skin and occasionally in other parts of diphtheria pseudomembrane formation, local lymph nodes, there may be "bull neck" and so on. diphtheria can still occur symptoms of airway obstruction, cicadas sound when breathing, or a "three depressions."
2. the performance of the circulatory system involvement, including fatigue, pale, cyanosis, difficulty breathing and other symptoms. physical examination with mild to moderate heart to expand, low heart sound blunt, like fetal heart sounds can be presented, tachycardia or bradycardia (mostly for the phenomenon of atrioventricular block), the apex may appear hair-like systolic and diastolic gallop murmur extensive myocardial lesions can cause cardiogenic shock, and more after the onset of the first 2 Zhou Fasheng, often first, pale skin, nausea, vomiting, abdominal pain and other symptoms, followed by limb Jueleng, thin pulse, blood pressure and other signs. In addition, the diphtheria bacillus toxin on the surrounding small blood vessels and the toxic effects of vasomotor center, could also be a cause of shock in this disease. There are also signs of congestive heart failure, including pulmonary congestion and circulation congestion symptoms and signs.
clinical symptoms of infection and throat patients with pseudomembrane formation, if the various manifestations of myocardial involvement, including ecg abnormalities, circulatory failure, or congestive heart failure may consider the existence of diphtheria myocarditis, bacteriology positive helps confirm the diagnosis.[Aftertreat]
l, black-bone chicken porridge astragalus wuji oral one, astragalus, 10 grams, 50 grams of rice, sugar amount. astragalus decoction juice stand; rice scouring the net, add some water porridge, when transferred to black-bone chicken cooked concoction oral liquid and Astragalus, sugar, cook for l ~ 2 boiling Serve. 1 day, 7 days a course of treatment. May benefit the heart qi, for myocarditis, heart palpitations, shortness of breath, spontaneous perspiration, moving the escalation.
2, pig heart pig heart a wheat porridge, wheat 30 grams, jujube 5, 50 grams of rice, spices amount. wash the pig heart, sliced, seasoned thicken back; take wheat broken, date to the core, with rice cooked as gruel, to be transferred after the pig heart film boiling, boil porridge cooked, seasoning take. 1 day, 7 days a course of treatment. function as above.
3, reference date Gui porridge codonopsis 10 grams ginger, jujube 5, Gui, 6 grams of dried ginger, 50 grams of rice, milk and brown sugar. decoction of various drugs juice, cooked with rice gruel, cooked, when transferred to milk, brown sugar, cook for l ~ 2 boiling Serve. Day 2, 7 days a course of treatment. Wenyang water can be applicable to spontaneous myocarditis palpitations, cold limbs, edema, oliguria, chest tightness, shortness of breath and so on.
4, jujube congee with pig pig Shenqi 100 grams, Codonopsis, astragalus, 15 grams, aconite 5 grams, jujube 5, 50 grams of rice, spices appropriate amount. The various syrup Jianqu dollars, increase rice cooked as gruel, to be transferred when cooked pig's blood and spices, cook for l ~ 2 boiling, take. 2 times a day, 7 days a course of treatment. May spleen Warming, qi yang Xin, yang and water pan for myocarditis limb edema, limb temperature, anorexia eat less, fatigue, breathlessness and chest tightness and even then, or with chest, ascites.
5, beef, beef, yam drink 250 grams of yam 120 grams. Beef, yam slices, cooked within 2 bowl, to the as tea, drink slowly, beef adorned take. May qi Hui Yang, yang desire for myocarditis off, hands spread open head, limbs not warm and so on.
6, beiqi sheep brain soup North 15 grams of astragalus, a sheep brain, spices amount. The sheep brain to the fascia, astragalus cloth, add some water with stew cooked sheep brain to Astragalus, transferred to salt, monosodium glutamate, onion, ginger, amount taken. Cong brain can benefit the heart, for lack of gas caused by heart palpitations, dizziness, limb soft fatigue, memory loss and so on.
7, polygonatum reference go pig heart five bamboo, Codonopsis, angelica 10 grams, a pig heart, spices amount. Cloth of various drugs, into the wash of the pig heart, add some water stew cooked pig's heart, remove the slices, to kits, back into the soup, boil, salt, MSG, ginger, green onion, pork fat transfer service. yang Xin qi can be applicable to the heart yin deficiency, blood deficiency, insomnia, dreams, palpitations, night sweats, irritability, throat less fluid and so on.
8, polygonatum odoratum sheep Tangxian 15 grams of sheep 1, spices amount. The sheep Wash, slice, add water, and sheep heart odoratum cooked with the stew, salt, monosodium glutamate, onion, ginger is not, take pig fat and other seasonings. May benefit blood nourishing the heart, for effort deficiency caused by heart palpitations, dry mouth, irritability, five upset hot.
2. to be small meals, not eating too full, especially dinner, to avoid increasing the burden of heart, the choice of lotus seeds, dates, yam, longan, turtle, etc. apricot weather, patients are often symptoms, can participate in the sand roses, Laoya Tang.
5. myocarditis patients in the diet does not have too many taboos. But gradually, as the physical condition of the warming. warming refers to the feeding hot food such as beef, mutton, eel, sweet, red dates, longan, lychee and ginger spicy food. Frail women eat cold foods can help Stoke to improve the feeling of cold in order to enhance physical fitness. With myocarditis, coronary heart disease were advised to wear some of the ginseng powder, can soothe the nerves cardiac, blood pressure Tongmai.
diphtheria myocarditis is best not to eat what food?
1. avoid spicy stimulation products: spicy stimulation products such as Beijing, onions, garlic, onion, polygonum Artemisia, mustard, chives, ginger, etc., can be gas consumption Shangyin. Modern medicine spicy products can stimulate the heart, the heart rate, increased metabolism, increased myocardial oxygen consumption, Diao; help myocarditis treatment and nursing. Therefore, myocarditis patients should not eat.
2. Avoid drinking strong tea and coffee: tea and coffee contained theophylline and caffeine have similar effects on the heart, an increase of heart rate, increased myocardial contractile force, which led to increased myocardial oxygen consumption. In addition, theophylline and caffeine can also stimulate the brain, so that the body be anxiety, excitement, and insomnia. This will not only hinder the myocarditis patient quiet rest, and can aggravate myocardial damage, causing severe arrhythmia.
3. Jijiu: Long-term alcohol abuse can damage the heart, myocardial degeneration and dysfunction. Spirits can also improve the body's metabolism, blood vessels, directly on the heart, causing heart rate, myocardial oxygen consumption increased, so that there is inflammation of the occurrence of more severe myocardial damage.
4. quit smoking: smoking a hundred harm. The heart, the nicotine contained in cigarettes and cigarette burning of carbon monoxide can make systemic vasoconstriction, decreased hemoglobin, resulting in increased burden on the heart, myocardial ischemia and hypoxia. Thereby increasing myocardial damage, arrhythmia and so on.
5. Xingshan avoid fat objects: acute myocarditis patients should avoid Xingshan products, such as rubber fish, mandarin fish, fish, octopus, eel, black fish, shrimp, crabs, etc. ; these things can help when the evil fat epidemic gas, stuffed phlegm damp, stasis heart network, thereby increasing myocarditis, the disease is not conducive to speedy recovery.[Prevent]
diphtheria myocarditis should be how to prevent?
2. cut off the transmission.
2. cut off the transmission.
syndrome: chills, fever, headache,, nasal congestion, runny nose, cough, chest pain, palpitations, muscle bitterness or dry mouth, abdominal pain, diarrhea, or fever while back There are sore throat, dry mouth, upset, palpitations, chest pain, fatigue, red tongue, white or yellow, few or knot generation.
Governing Law: Xin liang ease, detoxification.
main square: yinqiaosan subtraction
Governing Law: heart tonic air.
main square: Gomi decoction
3. Heart-Yin deficiency
main square: Tianwangbuxin Danga
4. heart and spleen
main square: always fried together Suanzaorentang subtraction
main square: always fried together Suanzaorentang subtraction
7. the heart is cured
main square: always fried together Suanzaorentang subtraction
Governing Law: qi and phlegm, Anshen.
main square: Dao Tan decoction
or knot generation.
Governing Law: blood circulation.
yang to Bupleurum, Campanulaceae, Zhuojia aconite, cinnamon, epimedium, Morinda.
1. aggressive treatment of primary disease such as diphtheria antitoxin to give 40,000 to 10 million U intramuscular injection or intravenous infusion after dilution. Preferred antibiotic penicillin 400,000 to 80 million U intramuscular injection, 1 / d, treatment 7 to 10 days. penicillin allergy use erythromycin 40mg / (kg · d), four times orally as above. In addition, rifampicin, clindamycin (clindamycin) is also effective.
2. absolute bed rest bed rest is generally not less than 2 months, until fully recovered heart, because sometimes very mild physical activity, such as sit up in bed , go to the bathroom toilet, which may cause sudden death.
4. to correct heart failure, heart failure and peripheral circulatory failure should be given a low sodium diet and limit water intake, caution digitalis preparations, will normally be given drugs lanatoside K (poisonous hairs spin Hanako glycosides K), for each adult 0.125 ~ 0.25mg, 50% of children in each 0.007mg/kg plus glucose 20ml, slow intravenous injection, as the condition can be applied to diuretics and vasodilators. digitalis dosage should be controlled in the conventional dose of 1 / 2 to 2 / 3, in order to avoid toxicity (digitalis drugs for patients at this time sensitive, prone to cause overdose, the application of the dose should be small, but the effect is more obvious) . Peripheral circulatory failure, such as concurrency available when dopamine, dobutamine, and metaraminol and so on.
5. to correct arrhythmias for bradycardia, atrioventricular block caused by reduced cardiac output, can be applied atropine, anisodamine or isoproterenol adding 0.5 ~ 1mg in 500ml 5% glucose solution intravenously slowly, if necessary, placement of temporary cardiac pacemaker. Such as ventricular tachycardia, especially ventricular tachycardia, lidocaine, benzyl ammonium bromide, or procainamide treatment, but the dose should be smaller than conventional dosage to avoid excessive myocardial suppression. Moreover, still need to pay attention to water and electrolyte balance, strengthen nursing and supportive care, are to be ignored.[Examine]
diphtheria myocarditis should be how?
2. pseudomembrane and bacteriology at the junction mucosa smear, the pap smear and culture, often can be found in Gram-positive bacilli or diphtheria bacilli. positive bacterial culture may be necessary to do testing bacterial toxins and virulence test.
1. you can see the early ecg ST-segment depression, t wave flat or inverted, sinus tachycardia common, followed by varying degrees of atrioventricular block, the occurrence of complete block ominous prognosis, and more death in the acute phase. others may have bundle branch block, sinus bradycardia, ventricular contractions, paroxysmal tachycardia, atrial flutter or fibrillation and other ecg abnormalities.
diphtheria myocarditis diseases easily confused?
1. myocarditis Rheumatic myocarditis rheumatic tonsillitis or angina often go far streptococcal infection, anti-"O" increased more significantly increased blood sedimentation, C reactive protein (CRP)-positive, ecg changes in PR interval prolongation is more common, often streptococcus throat swab material culture growth, and many have large arthritis, rheumatic myocarditis often given endocarditis, the mitral regurgitation systolic murmur and more obvious, and the valve may be due to edema, inflammation occurs diastolic murmur (Carey Coombs murmur), if the enlargement of the heart is not obvious, and more loud noise, the more likely rheumatic. Although diphtheria myocarditis myocarditis's performance, but more than a typical diphtheria performance, no diastolic heart murmur, ecg ST-T changes may have, PR interval prolongation and t wave changes, etc., take the pseudomembrane and mucosa at the junction cell line stained smears, often shows diphtheria bacillus, note from the above points were identified.
2. suppurative tonsillitis disease, acute onset, fever, sore throat, swollen throat, tonsils, or a bit like small pieces of yellow-white exudate, but loose and easy to erase, erase, after not bleeding. In order to identify the characteristics and diphtheria.
3.β intrinsic receptor hyperfunction syndrome more common in young women, often have a certain psychological factors as an incentive, complained more volatile, and objective signs of less no fever, elevated esr and other inflammatory evidence, mainly ST segment, t wave changes and sinus tachycardia, 20 ~ 30mg of oral propranolol after half an hour can make ST segment, t wave changes back to normal, diphtheria of myocarditis, ecg ST-T changes on the Department of myocardial damage caused by oral administration of propranolol can not be restored to normal shortly after. In addition, β-hyperfunction syndrome without cardiac enlargement, heart failure and other evidence of organic heart disease.[Disease]
aspirin allergy-related diseases
"5P" sign "cough water" addiction "three partial "syndrome asperger syndrome unresponsive to hiv infection Moro Todd paralysis (left temporarily aspirin allergy cancer rush fever septicemia accompanied by hypertension and white film mucosal bleeding baby with lively fear of pain, violence, lack of security outbreaks of impulsive behavior li was forced to sign off position difficult to turn a blind eye disease
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