Myocarditis is an inflammatory lesion of the cardiac muscle. Myocarditis can occur when any infectious disease, but currently myocarditis is most often seen in viral infections. To non-communicable factors that cause myocarditis are some medicines (antibiotics, sulfonamides, hydrochlorothiazide methyldopa and others), serum and vaccines. Myocarditis occur in systemic diseases of connective tissue, for example, in systemic lupus erythematosus and other systemic vasculitis.
Among the causes of inflammation of the myocardium special place emphasis on rheumatic fever, myocarditis, which is one of the main manifestations of the disease, along with the combination with endocarditis and pericarditis.
Depending on the reasons causing myocarditis, are distinguished:
- Infectious (viral, bacterial, riccetsiosny and others, including influenza, measles, rubella, chickenpox, diphtheria, scarlet fever, severe pneumonia, sepsis; the most common is the Coxsackie virus, is the cause of myocarditis in the half of the disease);
- Allergic (drug, serum);
- In the diffuse (systemic) diseases connective tissue, trauma, burns, exposure to ionizing radiation;
- Idiopathic (meaning unclear nature) myocarditis Abramov-Fiedler.
The leading role in the development of the inflammatory process belongs Allergy and immunity.
Causes of myocarditis
Myocarditis can be isolated (primary) and a manifestation of another disease (secondary).
Along the course there are acute, subacute and chronic myocarditis and recurrent (remission – improvements for several months or years). The inflammatory process in the myocardium leads to violation of its basic functions.
Symptoms of myocarditis
Myocarditis often occurs without symptoms and is sometimes recognized only after detection of ECG changes. In symptomatic cases, the typical complaints of patients on a diverse, long lasting, not associated with physical activity and pain in the heart, weakness, fatigue, shortness of breath and palpitations during exercise, interruptions in heart work. Body temperature may be normal, but more often, a slight increase to 37-37,90 S.
Myocarditis begins on the backdrop of infection or soon after with malaise, sometimes stubborn heart pain, palpitations and interruptions in his work and shortness of breath, and occasionally pain in the joints. Body temperature is normal or slightly increased. Onset may be visible or hidden. The severity of symptoms is largely determined by the prevalence and development process. Early increase heart size. Important, but not permanent signs are disorders of heart rhythm (tachycardia him increased, bradycardia, atrial fibrillation, extrasystoles) and conductivity (siege): palpitations, disruption of the heart, a feeling of “awe”, “stop”. Myocarditis may be complicated by the development of heart failure. Infectious myocarditis may occur in two forms: toxic, in which signs of heart failure appear during severe intoxication, infectious-allergic, in which signs of heart failure usually arise through 23 weeks after early acute exacerbation of chronic or infectious diseases.
Idiopathic myocarditis has a more severe, sometimes malignant course with the development of cardiomegaly increase in heart size, heavy rhythm and conduction, heart failure is often complicated by the development of heart failure, occurrence of blood clots in the heart, which, in turn, posted the bloodstream, causing necrosis (infarction) other agencies (thromboembolism).
Myocarditis in children
Myocarditis in a child, as an adult, occurs as the result of the actions of viruses and bacteria. For the child’s age is characterized by the presence of two types of myocarditis:
– Congenital myocarditis. In this case, the child since its birth suffer from lethargy, paleness, shortness of breath. Gets tired quickly when feeding, not gaining weight. This type of disease is characterized by a significant expansion of the boundaries of the heart palpitations.
– Acquired myocarditis. This type of myocarditis is divided into acute, sub-acute and chronic. Acute myocarditis is a consequence of SARS. Initial symptoms: lack of appetite, anxiety and night, the screams of the child, the attacks of cyanosis (bluing) and shortness of breath, nausea and vomiting. In the case of subacute and chronic myocarditis are marked as significant and minor symptoms. Minor include gepatomegalia (liver enlargement in size), tendency to fainting, vomiting. Significant cyanosis, cardiac hump (changing the shape of the chest over the heart area in the form of a hump), tachypnea (increased respiration).
Allergic myocarditis occurs after 12 to 48 h after injection of serum, vaccine or drug to which the patient is allergic. Myocarditis rheumatic and systemic diseases of connective tissue Symptoms do not differ from those in all other forms of myocarditis. Myocarditis is one of the symptoms of the underlying disease, which is set to the result of the survey.
Treatment of myocarditis
The prognosis depends on the form of the disease and its severity. Myocarditis Abramov-Fiedler, septic and diphtheria myocarditis prognosis for life is poor. In most cases of myocarditis are asymptomatic and ends on a full recovery. Other forms of myocarditis acute and sub-acute period of not less than 1/3 of cases complete recovery. The remaining patients observed outcome in cardiosclerosis, from the location and extent of which depends on the functional condition of the heart, or developing dilated cardiomyopathy. Known for extremely heavy course options myocarditis with the rapid development of refractory heart failure and death. Of cardiac arrhythmias can cause sudden death.
Prevention of myocarditis
Prevention is to prevent the effective and timely treatment of infectious diseases. The necessary readjustment of foci of chronic infection, chronic tonsillitis, periodontitis, dental caries. In the prevention of drug and serum myocarditis crucial rigorous justification of the indications for the application of serums and medicines including contraindications, especially if there is a history of allergies.
If the patient’s young age or a child who previously had no heart problems, against infection or after experiencing pain and discomfort in the heart, interruptions in heart work, you must immediately consult a cardiologist to get the necessary treatment.
The elderly suffering from any heart disease who suddenly appear a disruption of the heart, pain in the heart, which is not reduced in patients receiving usually effective drugs, it is also necessary to address to the cardiologist.
Not strictly specific signs of myocarditis. The diagnosis is based on clinical signs, changes in the electrocardiogram, echocardiography, laboratory signs of inflammation, changes on radiographs.
Usually myocarditis hospitalization is indicated. General measures include bed rest, restriction of physical activity, if necessary, inhalation of oxygen and medication.
Drug therapy depends on the underlying disease and the nature of cardiac activity. If not infectious viral myocarditis prescribe antibiotics, the choice of which depends on the selected pathogen and its sensitivity to antibiotics.
Other areas include the treatment of heart failure, disorders of heart rhythm and conduction, thromboembolic complications. In the first months after discharge from hospital patients with a history of myocarditis should be under the supervision of, the need to limit physical activity.