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   The discussion of myocarditis by clinicians basically revolves around viral myocarditis, because 9 out of 10 patients have viral infections.

  Dilated cardiomyopathy, like myocarditis, is caused by immune factors and virus infection. Among them, enterovirus and cytomegalovirus infections detected in myocardial biopsies have been shown to be directly associated with dilated cardiomyopathy. Coincidentally, myocarditis also has these two viral infections.

   Lee Seung-won and Dr. Dong are arguing here. Indeed, it has not been determined for the time being whether this infection caused the occurrence of two diseases at the same time, or whether one disease occurred first and then gradually led to the emergence of the other.

   What is the point of this argument? Because of the occult myocarditis mentioned by Xie Wanying just now, clinicians failed to detect and perform examinations in time, which eventually led to the death of patients with heart failure.

   Li Chengyuan denied her claim, believing that the patient did not have occult myocarditis at all, but had dilated cardiomyopathy at the beginning, so it could not be detected clinically. The initial symptoms of dilated cardiomyopathy can be more insidious, the onset is slow, and the course of severe symptoms can last more than a decade.

  Dr. Dong agrees with Xie Wanying's point of view, which is equivalent to his belief that as long as it is a viral myocardial infection, there should be a process from myocarditis to dilated cardiomyopathy. The reason is that he has seen many such patients clinically.

   Here is the difference between a physician and a surgeon. Patients with myocarditis generally do not go to the cardiothoracic surgery department, but first go to the cardiovascular department for drug treatment. It is necessary to wait until the patient has complete heart failure and considers a heart transplant before being transferred to surgery for surgery. Surgeons recognize only anatomical findings, myocarditis is deformation and necrosis of cardiac muscle cells, and dilated cardiomyopathy is characterized by enlarged ventricles. How can it be the same?

   "Persistent myocarditis can lead to myocardial remodeling." Xie Wanying said.

   "Yes. As she said, that's it." Dr. Dong applauded her words with clapping hands.

   Li Chengyuan did not back down: "You can't 100% prove that dilated cardiomyopathy is derived from persistent myocarditis. It is possible that both occur at the same time."

  Xie Wanying suddenly thought of something after listening to the senior's words, and stopped her mouth.

  Huang Zhilei and Xin Yanjun whispered: "The two of them are quarreling, what are they quarreling about? Now we should suspect that it is myocarditis, right?"

  Elevated troponin represents myocardial damage. As one of the important indicators for auxiliary diagnosis of myocarditis, it has clinical guiding value. To diagnose myocarditis, patients need to have clinical symptoms related to myocarditis, such as chest pain, chest tightness, panting, heart failure, and palpitations. If the patient has no obvious symptoms, other tests are needed to confirm whether it is myocarditis. Therefore, this patient is now in the initial stage of the doctor's suspicion of myocarditis. Next, the patient should be given an electrocardiogram and echocardiogram as soon as possible.

   If you want to ask the gold standard for myocarditis, it must be an endomyocardial biopsy.

  Since Xie Wanying heard the possibility of ventricular dilatation by auscultation, at the suggestion of Dr. Li Chengyuan, it was suspected that dilated cardiomyopathy should be added to the diagnosis.

   (end of this chapter)