Myocarditis is a lesion of the myocardium (cardiac muscle), which has mainly an inflammatory etiology, caused by the effects of various infestations, infections, physical and chemical factors, and arising as a consequence of autoimmune or allergic diseases.
As a rule, myocarditis develops as complications of various pathologies and the incidence of their occurrence is unknown. For example, in diphtheria, this disease occurs in 30% of patients, and the mortality in this case from cardiac complications reaches 55%. Diagnosis of myocarditis in ARVI is observed in almost 15%.
In some cases, myocarditis is a consequence of cross-autoimmune changes. Myocarditis of the immune etiology can occur as an independent disease, as a syndrome of systemic pathology of the cardiac tissue, and in allergic processes of delayed action.
Also, the formation of myocarditis can be affected by toxins or physical factors. Data of pathoanatomical studies with signs of inflammatory myocarditis provide indices of autopsies in the form of 4-8%.
As a rule, this disease affects people from thirty to forty years. And women are sick more often, unlike men. But a strong half of humanity has a more severe symptomatology of the disease. However, until today, the exact causes of myocarditis development and all issues related to its mechanism of education, clinical diagnostics and a kind of therapy have not been clarified, although myocarditis has been isolated as an independent disease more than two hundred years ago.
Myocarditis of the heart
For such cardiac pathology, inflammation of the myocardium is typical due to infections of various etiologies, negative consequences, after the use of medicines, disorders in the immune system that cause damage to the cells of the cardiac tissues and the action of various types of toxins.
As a rule, myocarditis is characterized by asymptomatic course with the onset of self-recovery. In addition, it was noted that women are more likely to contract myocarditis than males. But in the latter category of patients this pathology proceeds in very severe forms. Statistically, myocarditis of the heart is more common in the reproductive age until about forty years.
The occurrence of myocarditis of the heart can be influenced primarily by infections and toxins that enter the body. Basically, this is a viral etiology in the form of HIV, measles , infectious hepatitis, adenoviruses, infectious mononucleosis and influenza viruses.
Among the bacteria that cause cardiac myocarditis, there are: meningococcus, streptococcus, gonococcus, diphtheria bacillus and mycobacterium tuberculosis. Lesions of fungal nature, namely aspergillosis, actinomycosis and candidiasis. Also, various allergic reactions can provoke the formation of myocarditis of the heart. All this can be caused by the negative effects of drugs on the myocardium, as a result of which the immune system promotes the production of antibodies against their cells and tissues, causing their damage. Of course, the use of narcotic drugs and alcoholic beverages, like toxic substances, causes structural damage to the myocardium. To causes of a toxic nature include diabetes and thyroid diseases.
The symptomatology of myocarditis of the heart does not have a definite clinical picture, due to which it could be diagnosed this disease in 100%. In general, myocarditis of the heart is considered a secondary pathology after the disease. And in many cases it is possible to trace the connection between various heart diseases and the transferred infections.
At the very beginning of the disease there are pains in the cardiac region with further spreading to the entire chest area, which appear after physical exertion, and also in a calm state. Then, labored breathing develops in the form of dyspnea after performing any physical actions, which is due to an inadequate contraction of the heart. The majority of patients have frequent heartbeats, which leads to a fainting condition, dizziness and edema of the lower limbs. All of these symptoms, especially after an infectious disease has been transmitted, are a signal to the cardiologist.
Myocarditis of the heart in its diagnosis goes through several stages. Firstly, a patient's history is collected, which includes the transferred infectious pathologies with a feverish course of the disease, painful attacks in the joints or muscles. In addition, whether there are heart pains, whether there is severe fatigue over the last time and whether there is a rapid heart beat.
After this, an expanded blood test is performed to diagnose an increased number of leukocytes and ESR, although these indicators may be unstable. It is also necessary to make an electrocardiogram and to remove daily monitoring by the Holter method. However, it is not always possible to determine cardiac myocarditis with ECG. Therefore, it is necessary to use other diagnostic methods in the form of X-ray research, which fully shows the extent of the increase in the boundaries of the heart and the stagnant processes of blood in the lungs. And sometimes resort to a biopsy of the heart muscle.
Also, when prescribing and conducting diagnostic studies, it is necessary to remember about metabolic, endocrine and general diseases, as the main cause of myocarditis of the heart.
In the treatment of this pathology, the functional work of the immune system is corrected and various complications are attempted to be stopped. First of all antiviral drugs are prescribed, since the main etiology of myocarditis is a viral infection. These can be Immunoglobulins, Interferon and Riboverine. But these medications have a negative effect on the patient's immunity, so now they are more often used in the treatment of the disease. Transfer factor Cardio, which eliminates damage in the DNA chain itself, having in its composition transfer factors are special molecules of the immune system. This immunomodulator does not cause side effects in the body and is recommended to almost everyone, from birth to old age, and even during pregnancy, since it has no contraindications. This TF cardio should be for every patient with a diagnosis of myocarditis of the heart, because he is today the best cardiac agent in the complex treatment of this disease.
Cause of myocarditis
As a rule, under the myocarditis means a lot of pathologies of the cardiac muscle with inflammatory etiology, which are manifested by various lesions and disorders of the heart muscle. One of the most frequent causes of the disease are all kinds of infections, such as hepatitis B and C, influenza , herpes , adenoviruses. Also the development of the disease can provoke a variety of bacteria, fungi and parasites, namely salmonella, coryneobacteria diphtheria, streptococci, rickettsia, staphylococcus and chlamydia; candida and aspergilla; echinococci and trichinella, and others.
Myocarditis in severe form can develop after suffering sepsis, scarlet fever and diphtheria. In 50% of myocarditis is formed as a result of high cardiothrogenicity of some viruses. Sometimes this disease appears as a consequence of such connective tissue diseases as rheumatism, systemic lupus erythematosus , vasculitis , allergic diseases and rheumatoid arthritis.
Very often toxic substances lead to the development of myocarditis of the heart. They can be medicines, alcohol and drugs. Myocarditis of idiopathic character proceeds quite heavily and is characterized by an unexplained etiology.
As a rule, myocarditis develops in combination with pericarditis and endocarditis. It is very rare to observe inflammation in only one myocardium. Sometimes myocarditis is infectious-allergic.
Very often, myocarditis can be triggered by acute infections, usually viral; foci of chronic diseases. And also allergies , as a result of impaired immunological reaction and toxic effects.
Disturbances in the immune system, which are observed in myocarditis, are characterized by damage to the cellular and humoral units in the immune system, as well as phagocytosis. An infectious antigen includes the processes of autoimmune damage to cardiomyocytes, which cause dystrophic changes in the muscular structure of the heart. As a result of inflammatory changes in myocarditis connective tissue grows, which becomes the cause of the development of cardiosclerosis in the future.
All this reduces the contractile function of the myocardium with an irreversible process and leads to insufficient work of circulatory processes, violation of cardiac contractions and even death.
The main complaint of patients with myocarditis is pain, which is localized in the heart. As a rule, in 60% of cases it is detected with non-rheumatic myocarditis, infectious and allergic. But with tonsillogenic myocarditis, this pain occurs in 93% of patients.
In general, there are no changes in the pericardium. In this case, the pain resembles an anginosa, which is noted with a prolonged attack of angina pectoris or as a heart attack. Pain with myocarditis radiates mainly to the left side of the arm, shoulder, neck, and sometimes localized in the interblade area. Very often the pain is on the left side of the chest, which distinguishes it from pain in myocardial infarction.
As a rule, the occurrence of pain or its enhancement can be affected by physical activity, but sometimes it develops at absolute rest. Continue painful attacks can be up to several hours, and for them, it is characteristic of repeated repetition throughout the day. Some patients feel them constantly, but this is observed in extremely rare cases. Most often this pain is stitching or aching without irradiation. Sometimes anginal pain can alternate with pain of a different nature and intensity in the upper part of the heart or in the precordial region. In some moments of pain can accompany pericarditis.
Practically in 50% of patients with myocarditis there is shortness of breath, which is caused by physical strains, even sometimes insignificant. Myocarditis in severe current is characterized by difficulty breathing at rest and suffocating attacks during sleep, namely at night.
To frequent complaints of patients can be attributed to a malfunction in the work of the heart, which manifests itself in the form of calm heart rhythm, and then the appearance of a heartbeat. As a rule, heartbeat begins and stops gradually, but sometimes it can be expressed by paroxysmal tachycardia. It is very rare to observe a chaotic heartbeat, which is symptomatic of atrial fibrillation.
In addition, there is weakness in the patients, they begin to sweat and complain of pain in the head, dizziness and a tendency to fainting. For myocarditis nonspecific infectious and toxic-allergic nature sometimes characterized by arthralgia.
The general symptomatology of myocarditis consists of increased weakness and fatigue in patients, but this is not always the cause of myocarditis. Therefore, the disease can be detected on the ECG, X-ray examination or accidental medical examination.
Also in very rare cases with myocarditis there is a high temperature rise, which may be due to the underlying disease of the patient. But low-grade fever is noted quite often in almost 50% of patients.
At visual inspection do not reveal characteristic changes at patients. Sometimes such patients are slightly pale, having a history of heart failure with acrocyanosis, tachypnea in rare cases, and in severe cases, orthopnea, pastoznost or puffiness of the lower limbs. When manifestations of insufficient work of the right ventricle, anasarka comes.
With myocarditis, tachycardia is most often heard, but the heart rate can be either normal or low. In many patients extrasystole is found, and for the terminal stage a threadlike pulse is characteristic.
Arterial pressure in myocarditis is almost always reduced. Myocarditis, which has a systemic disease, can have an etiopathogenetic factor and arterial hypertension, as a common symptom. Lowering blood pressure can be due to poor contractile work of the heart in conjunction with an insufficient function of blood vessels. If there is a severe damage to blood vessels with toxins or characteristic disturbances in their conductivity, then collapse develops.
When percussion is detected the left border of the heart, shifted outward, sometimes the heart expands from two sides or only to the right side. The heart beat on the tip is usually weakened or not palpated at all. But with augmentation of the heart there is a push of a soft, diffuse nature.
With myocarditis heart sounds are muffled or deaf. And for the severe form of myocarditis is characterized by a heart rhythm in the form of a pendulum, in which it is difficult to determine where the first tone, and where the second. There is also a diastolic rhythm in the form of a gallop, characteristic of heart failure. Most patients with myocarditis have systolic murmur in the upper part of the heart. With myocarditis of unspecific etiology, presystolic murmur is determined, which simulates the noise of mitral stenosis.
Non-rheumatic myocarditis can have an acute, subacute, chronic progressive and chronic recurrent course. The acute form of the disease is characteristic of myocarditis with an infectious etiology. This especially applies to viral infections, typhus, diphtheria, etc., when pathogens or their toxins directly affect the myocardium. Also, acute myocarditis occurs during chemo-toxic and radiation damage to the heart muscle. But infectious and toxic-allergic myocarditis can proceed from acute forms to slowly flowing chronic forms. Chronic forms can, both progress and recur. The symptomatology of recurrent myocarditis arises against the background of an exacerbation of the infection, a stressful situation, hypothermia, etc.
Myocarditis in children
With this disease, it is possible to introduce agents of infectious etiology directly into the heart muscle, but in general, myocarditis in children is characterized by an infectious-toxic or infectious-allergic genesis.
Children's myocarditis, as a true disease, is still not fully understood.
The main causative factors that contribute to the formation of myocarditis, especially at an early age, are Coxsackie viruses, ECHO, much less often respiratory viruses, etc. Very often, myocarditis is detected after sepsis of various etiologies, acute septic endocarditis, and collagenosis.
In addition, parasitic and protozoal myocarditis, as well as allergic and toxic, are observed. But with scarlet fever, tuberculosis, typhoid and diphtheria, myocarditis is detected a little less, which is associated with early diagnosis of the underlying disease, its effective treatment and prevention.
Myocarditis in children is almost as well classified as in adults, but they distinguish certain features in the form of congenital myocarditis, which develops during fetal development as a result of infection of the mother during pregnancy by various infections. These include rubella, enterovirus and bacterial infections, as well as parasitic and other diseases. Nearly one-third of children at an early age who develop non-rheumatic myocarditis find changes in the endocardium and pericardium.
In children, myocarditis is combined with the pathology of the central nervous system, especially this refers to viral encephalomyocarditis, congenital toxoplasmosis, cytomegaly generalized.
Symptomatic myocarditis in the period of newborn and early age is composed of an acute or subacute course of the disease, which often occurs in severe form. Postnatal myocarditis develops after an infectious disease or in his period. With a subfebrile condition, and sometimes a high temperature, the child becomes pale with a gray or cyanotic skin tone, he has lost interest in everything around him. The baby becomes tired during the sucking of milk, then refuses breastfeeding, begins to lose weight, becomes capricious and becomes adynamic and lethargic.
When appointing an X-ray examination for myocarditis, it is possible to determine the extension of the heart boundaries to the left. When listening, a weak and diffused heart beat is noted. Very strongly the heart sounds are muffled, and sometimes completely deaf. In this case, a pathological third tone is defined as a gallop. Myocarditis in children is characterized by tachycardia, embryocardia, and sometimes bradycardia , which is caused by conduction disorders.
Isolated myocarditis is characterized by a short, unstable systolic murmur with a soft tone. Sometimes noise can be amplified as a result of inadequate operation of valves, muscle dysfunction, prolapse of the valves, and also after inflammatory damage to the valves. If the cardiac output significantly decreases, and the insufficient work of the vessels and adrenal glands is attached to it, the collapse or chronic form of the collapoid state may develop.
Symptomatic of severe myocardium in infants is marked paleness at the initial stages of the disease, anxiety, sleep deterioration, anorexia , coughing, shortness of breath in the form of dyspnea during feeding, defecation, bathing, swaddling. And already at the late stages of myocarditis development, shortness of breath and tachycardia appear also at rest.
With the progression of insufficient work of the right ventricle, the child has general pastovity, swelling of the hands and feet, and also in the pubic region and abdominal wall. Such children begin to gain weight very quickly, which is due to swelling. They are noted oliguria, hepatomegaly and often splenomegaly. In addition, proteinuria is possible with the appearance of blood in the urine.
With myocarditis in severe form, where insufficient functioning of the left ventricle predominates, pulmonary heart develops, as well as lymphostasis, edema of interstitial properties, periodic signs of edema of the alveoli, characterized by wet wheezes on both sides, respiratory depression and increased cyanosis. Sometimes there are attacks of acute form of pulmonary edema, leading to poor outcome.
In older children, myocarditis can also occur in three forms (acute, subacute and chronic recurrent). But, as a rule, the disease has a benign course. After the infection, the disease for almost three weeks does not manifest itself. At the very beginning of myocarditis, there is asthenia, very fast fatigue, pallor and weight loss, but the temperature can be either normal or rise to low-grade figures. Sometimes there are pain in the head, abdomen, frequent dizziness, as well as arthralgia and myalgia.
In children with myocarditis, complaints of heart beat and pain in it appear in almost 18% of cases. The painful form of myocarditis is not excreted in children as a result of a little intense cardialgia. But with their duration, it is very difficult to stop with antispastic drugs and analgesics. Symptomatology caused by difficulty breathing and the appearance of cyanosis, is expressed in these children is insignificant. This is mainly observed after physical overstrain. It is also very rare to distinguish the enlarged borders of the heart, muffled tones and tachycardia. However, in this case, the children are disturbed by the rhythm of the heart, in the form of a migrating or nodal rhythm. For a non-severe variant, the syndrome of the weak sinus and atrial node is characteristic, as well as violations of the contractile work of the cardiac muscle (myocardium). All this clinical symptomatology testifies to focal myocarditis.
As a rule, myocarditis unfavorably occurs in infants and very young children, which is marked by the development of chronic progressive processes in the myocardium or the death of the patient. Basically, in this category of patients against the background of inflammatory changes in the heart muscle, cardiosclerosis, fibroelastosis, and elastofibrosis develop.
But in pre-school children and schoolchildren, myocarditis can be cured, but there are peculiar violations of cardiac contractions due to cardiosclerosis.
This disease most often can occur with different forms of infection, such as chronic tonsillitis, typhoid, diphtheria, viral pneumonia, scarlet fever and sepsis. Changes in the heart muscle can be diffuse or focal. Diffuse myocarditis is characterized by damage to the working muscles, which leads to insufficient work of the heart. For focal myocarditis, the damage to a system that produces and conducts impulses is inherent. Thus, the clinical symptomatology is due to various heart rhythm disturbances.
Symptoms of infectious myocarditis are presented in the form of an enlarged heart in diameter, deaf tones, especially the first. In addition, a muscular noise is heard. Tachycardia refers to an early symptom of infectious myocarditis. In this case, the increase in heart rate is not due to increased temperature, but as a result of myocardial weakness. Sometimes there is a bradycardia, which can appear as a consequence of lesions of the sinus node. With severe myocarditis and tachycardia, embryocardia occurs. Sometimes, extrasystolic and atrial fibrillation is diagnosed. In rare cases, cardiac blockade occurs. With a significantly reduced tone of the myocardium, a rhythm of the gallop type is noted, and AD is decreased.
Severe form of infectious myocarditis is characterized by pallor of the skin, pain in the heart and shortness of breath. In this case, vascular insufficiency can be observed.
Infectious myocarditis is heavily diagnosed in mild form with acute and subacute course.
For example, myocarditis in viral influenza attracts by its defeat not only the myocardium, but also the nervous apparatus that regulates the activity of SS. In this case, there are pains in the heart, resembling angina. The heart increases in diameter with the audible noise of the systole at the top.
With myocarditis against the background of diphtheria, cardiac blockade and various arrhythmias are observed. Also, heart palpitations are characteristic, and in cases of damage to the conductor system, shortness of breath, cyanosis , bradycardia, pallor, etc., are revealed.
Structural change of the cardiac muscle in tonsillitis is symptomatically manifested by unpleasant sensations, frequent pains in the heart, heart beat, tachycardia, dyspnea. Sometimes the temperature rises, articular pain and hypotension , as well as extrasystole arise. For diagnosis, it is necessary to observe to exclude rheumatic carditis. To treat this infectious myocarditis, the therapy of the main pathology is applied, and according to indications - tonsillectomy, which gives a positive result.
The course of infectious myocarditis in most patients passes favorably with the possible absolute recovery. In a certain category of patients, myocarditis leaves scars on the heart, and this gradually leads to the development of persistent and progressive heart failure.
The acute form of myocarditis is characterized by inflammation of the myocardium (cardiac muscle). For acute myocardium, there are bright symptoms that cause the formation of various arrhythmias, insufficient work of the heart, and can also cause death of patients.
The treatment of any disease is based on its diagnosis and on the cause of this pathology. When diagnosing myocarditis, it is necessary to take into account both external symptoms, and the state of tissues, as well as organs. For a long time, doctors did not know what happens to the cardiac tissues in myocarditis, but since the 1980s, after the discovery of the transvenous biopsy, they have learned to make a clinical picture of the inflammatory processes taking place in the heart. Thus, began to divide myocarditis into rheumatic, infectious and allergic, which all have an acute course of the disease. In this case, we mean acute myocarditis. This form of myocarditis depends on the cause, which affects the formation of the pathology of the heart.
Myocarditis of unexplained etiology is called idiopathic myocarditis.
Acute myocarditis proceeds almost asymptomatically, without manifesting itself as bright signs. But he always stands out for his characteristic clinical picture: chest pain, cyanotic skin, shortness of breath, increased weakness, heart rhythm disturbance, edema of the lower extremities. In acute myocarditis, the heart becomes significantly enlarged, which is found during radiographic examination.
To clarify the diagnosis appoint an electrocardiogram, heart echography, chest X-ray, general, biochemical and immunological analysis of the blood, sounding of the heart cavity, MRI, biopsy. All these examinations make it possible to accurately diagnose acute myocarditis and prescribe appropriate treatment.
Electrocardiography is one of the leading places in the diagnosis of this disease. At the same time, it is possible to determine the violations associated with atrioventricular conduction. As a rule, this is in the first and second degree, almost to the absolute and intraventricular blockade and extrasystole.
Changes on the ECG mainly affect repolarization. This is characterized by a decrease in the height of the T wave at the very beginning of the myocarditis, and then the ST segment sometimes shifts down, and after a couple of weeks a negative T wave is formed, which is characterized by long-term stability in this position.
With X-ray diagnosis of the myocardium, there are enlarged areas of the heart muscle, and sometimes the whole heart, in the diffuse form of myocarditis. In addition, the X-ray makes it possible to determine the smoothness of the arches and various stagnations in the circulatory system of the small circle.
With the help of echocardiographic research, it is possible to detect a reduced ejection fraction, indices that characterize the myocardial ventricular component, and also an increased heart volume in the remainder.
Quite often laboratory diagnosis facilitates the establishment of myocarditis. With the help of an expanded blood test, leukocytosis is determined, in which it is possible to detect a neutrophil shift in the left side, and sometimes even moderate eosinophilia and an increase in ESR.
Biochemical studies can detect increased activity of aminotransferases, MB fractions and globulins.
Laboratory tests allow to determine not only the inflammatory signs of myocarditis, but also the allergic process - an increased number of basophils and eosinophils, their test degranulation, the active phosphatase process in neutrophils.
The use of symptomatic, pathogenetic and etiological treatment as a whole is possible only in some cases, that is not always.
To treat the acute form of infectious myocarditis caused by some fungi, protozoa and bacteria, etiotropic therapy with the use of antibiotics and chemotherapy is used. To date, there is no specific treatment for viral infections. With allergic myocarditis of drug etiology, it is necessary to suspend the use of the drug, and at certain times not even to contact with it.
All treatment of myocarditis symptoms should be based on the therapy of the underlying pathology.
At the very beginning of the disease, patients are assigned to bed rest, even if there are absolutely no signs of insufficient heart function, for the purpose of prevention.
Since in the pathogenesis of some myocarditis there is an allergic factor, then hypensensitization is widely used. Among the potent drugs of this group are Dexamethasone, Triamcinolone and Prednisolone. It is also known that glucocorticoids in high doses can generalize focal infection, but, nevertheless, they are prescribed under the cover of antibiotics. Most researchers claim the positive effect of this group of drugs in myocarditis with various causes of its formation. First of all, it concerns the most severe forms of the disease, for example, myocarditis Abramov-Fiedler. As a rule, the daily appointment of Prednisolon should not exceed thirty milligrams, and in the future the dosage is reduced.
With myocarditis of a prolonged or recurrent nature, salicylates are used in the form of Acetylsalicylic acid, Metindole, and Butadion, Brufen, Hingamine and Hydroxychloroquine. In this case, antihistamines and ATP with Cocarboxylase will also be ineffective.
Some salicylates relieve pain syndrome, which develops in various forms of myocarditis. With anginal pain of stubborn nature, Anaprilin is used, giving good results. But it is important to always remember that this drug in large doses promotes the development of cardiac pathology in the form of insufficiency.
Myocarditis, which develops as a consequence of bacterial infection, is treated with antibacterial agents. Oksatsilin, Monocycline, Doxycycline and Penicillin are most often used. Also sanitize chronic infectious foci, which lead to a safe outcome of myocarditis.
Sometimes, to avoid complications of thromboembolic character, Heparin is appointed. And for the treatment of tachycardia and other rhythm disorders, antiarrhythmics are used.
With persistent disturbances of the rhythm, a surgical operation is shown in the form of implanting an external pacemaker in the heart.
It is important to remember that those who have had myocarditis should avoid heavy physical exertion, keep to a diet, and try not to overcool. In cases of dyspnea or swelling of the lower extremities, it is necessary to immediately consult a cardiologist.