怀疑新冠相关心肌炎，需要做哪些检查？

仅供医学专业人士阅读参考

诊疗大小问题，看看指南怎么说

《新型冠状病毒感染相关性心肌炎简明诊治建议（第一版）》：

01

实验室检查

1）心肌损伤标志物：肌钙蛋白最为敏感和特异，持续性增高说明心肌持续进行性损伤和加重，提示预后不良。

2）脑钠肽（BNP）或氨基末端脑钠肽前体（NT-proBNP）：正常或升高，如显著升高，提示心功能受损严重，对合并重症肺炎者有重要鉴别诊断价值。

02

心电图

1）在新冠病毒感染相关性心肌炎诊断过程中，心电图的敏感度较高，但特异度低，应进行多次检查，比较其变化。

2）所有患者均应行24h动态心电图检查。

3）心电图表现：①窦性心动过速最为常见；②频发房性早搏或室性早搏及短阵室性心动过速；③出现束支阻滞或房室传导阻滞提示预后不良；④肢体导联特别是胸前导联低电压提示心肌受损广泛且严重；⑤ST-T改变常见部分患者的心电图甚至可表现为类似急性心肌梗死的图形。

03

超声心动图

新冠病毒感染相关性心肌炎诊断和随访意义重大，建议根据病情动态观察。可见以下改变：

1）室壁运动：轻症者可正常，重症可见弥漫性室壁运动减低；

2）心脏收缩功能：轻症正常，重症可见左心室射血分数显著降低；

3）心腔大小：多数患者心腔大小正常，仅少数患者心腔稍扩大，极少数明显扩 大。

04

胸部X线或胸部CT检查

所有疑诊患者均行胸部X线检查或胸部CT检查，有阳性发现或危重患者进行动态监测。

05

冠状动脉造影

临床疑似心肌炎，但心电图有缺血、梗死改变，或年龄较大需排除急性心肌梗死的患者，应立即行冠状动脉造影。

06

心脏磁共振成像（MRI）

疑诊患者在血液动力学稳定等条件许可时可进行MRI，在出现心肌炎最初临床表现后2-3周灵敏度最高；但是鉴于MRI在心肌炎发病早期的阳性率较低，必须慎重选择。

07

经皮心内膜心肌活检

对临床疑似心肌炎的患者需考虑行心肌活检。

新冠相关心肌炎，有哪些症状？

新冠相关心肌炎，如何治疗？

新冠病毒心肌炎的发病机制是？

打开决策助手App临床指南模块，对话各大指南

国内外权威指南

决策助手“临床指南”模块都有

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