MYOCARDITIS

Myocardium - an inflammation of the myocardium. Occurs when different diseases as a result of myocardial damage by infectious agents, toxins (poisons) of different origin as either an allergic or autoimmune reaction. Myocarditis can be an independent disease, or part of some other disease such as diffuse connective tissue diseases. Among the causes of myocardial inflammation rheumatism assign a special place in which myocarditis is one of the main manifestations of the disease, along with a combination of endocarditis and pericarditis.

Myocarditis is often observed in acute viral and bacterial infections (infectious myocarditis), including the flu, measles, rubella, chickenpox, diphtheria, scarlet fever, severe pneumonia, sepsis, and others. Non-infectious myocarditis occurs in some cases of poisoning, especially under the influence of factors, affecting the immune system, such as the introduction of serum (serum myocarditis), taking certain medications (drug myocarditis). There myocarditis of unknown etiology such as idiopathic myocarditis Abramov-Fiedler.

The clinical manifestations and course. When viral and infectious-toxic myocarditis signs of heart lesions appear during severe intoxication; infectious-allergic myocarditis usually occurs within 2-3 weeks after the start of acute or exacerbation of chronic infectious diseases; myocarditis serum - 12 - 48 hours after administration of serum.

myocarditis often occurs without obvious symptoms and is sometimes recognized only after the detection of ECG changes. In symptomatic cases are typical complaints of patients to various in character, prolonged non-exercise pain in the heart, weakness, fatigue, shortness of breath and palpitations during exercise, disruption of the heart. Body temperature may be normal, but more marked low-grade fever. Objectively identify expansion of borders of the heart, tachycardia (sometimes bradycardia), I muted tones of the heart, or the splitting of a split tone, accent II tone of the pulmonary trunk, sometimes systolic murmur at the point Botkin. In severe cases, can be auscultated gallop rhythm, diastolic murmur. Often detected extrasystoles, atrial fibrillation, a rhythm and a rare loss of individual heart rate may be due to atrioventricular block. The progression of heart failure, typical of diffuse myocarditis, manifested increase of breathlessness, swelling of the neck veins, appearance of orthopnea, cardiac asthma, pulmonary edema, ikrotsianoza, peripheral edema, enlargement of the liver, sometimes the appearance of hydrothorax and ascites.

Current myocarditis can be acute, subacute, and chronic progressive or relapsing (with the presence of remission for several months or years). Acute and subacute often occur infectious, toxic, serum and Radiation myocarditis. Infectious-allergic and toxic-allergic myocarditis sometimes become chronic.

Myocarditis with influenza, measles, rubella, varicella often has no clinical manifestations, but it may be suspected when it detects tones voicelessness and especially disorders of conduction and heart rhythm, which often (in the outcome of measles, rubella) persist after recovery. For myocarditis caused by the Coxsackie virus, is characterized by its combination with endocarditis and pericarditis, symptoms of which may predominate; in some cases, develop heart failure . When myocarditis caused by a virus of polio, heart failure often develops acutely and combined with acute circulatory failure.

Myocarditis Abramova -Fidlera detected in the majority of cases in the period of pronounced clinical manifestations, including a variety of cardiac arrhythmias, conduction, and a picture of progressive heart failure, difficult to treat. At the heart cavities often form blood clots, large vessels thromboembolism and pulmonary circulation can complicate diagnosis of the underlying disease.

And D and r and s. Suspected myocarditis should be in instances of cardiac function - excitability (ekstrasistolyatsiya, paroxysmal rhythm disturbance), contractility (shortness of breath and other symptoms of cardiac contractility), conductivity (the most characteristic appearance of atrioventricular block) in patients not suffering from pre-existing heart disease (especially among young people age). When collecting medical history is necessary to pay attention to the relationship of these symptoms to a previous infection, intoxication, administration of sera and others. The diagnosis can help percussion data (increased heart size), and auscultation of the heart (tone deafness), backed up by the results of instrumental and laboratory research.

X-ray reveals enlargement of the heart shadow ripple reduction for ventricular contours signs of stagnation of blood in the lungs. ECG changes are present in all cases of myocarditis; in addition to rhythm and conduction disturbances, changes are detected the final part of ventricular complex - ST segment and T wave About myocarditis suggests raising blood alfa2- and gamma globulins, and the so-called cardiac enzymes - aspartate aminotransferase, creatine phosphokinase and individual fractions of lactate dehydrogenase, but the latest content blood and increases in acute myocardial infarction. In some cases, there lymphocytosis, eosinophilia. Leukocytosis and increased ESR are not specific, but their availability (usually the 3rd week of the disease) facilitates the exclusion of myocardial lesions noninflammatory nature.

The differential diagnosis is carried out with myocardiodystrophy different etiology (including with thyrotoxicosis, anemia , and other alcoholic intoxication), kardiosklerosis, cardiomyopathy, various manifestations of coronary heart disease, including atypical forms of acute myocardial infarction. Unlike angina observed in ischemic heart disease, heart pain in myocarditis lasts for hours, sometimes permanent, localized, usually not in the sternum, and the left side of the chest; AD is often reduced.

Treatment. When presumptive diagnosis of acute (subacute) or relapse of chronic myocarditis patients need to be hospitalized. In the case of pronounced heart rhythm disorders, manifestations of heart failure patient is subject to immediate hospitalization. At the hospital it is delivered on a dedicated transport, accompanied by medical staff, which provides emergency assistance when necessary (applying antiarrhythmics, cardiac asthma relief and so on. D.). Assign bed rest, diet with restriction of salt. Drug therapy depends on the nature of the underlying disease, and cardiac disorders. With infectious myocarditis and in the presence of infection in patients with infectious-allergic myocarditis spend antibiotic or other causal treatment. When myocarditis, which are based on allergic reaction, use glucocorticoid hormones (in severe disease) or nonsteroidal anti-inflammatory drugs (salicylates, indomethacin, etc.), With protracted course use delagil. Additionally, use tools to improve myocardial metabolism (Riboxinum, potassium orotate). If necessary to antiarrhythmic therapy, treatment of heart failure; used diuretics, vasodilators (phase contraindicated the use of cardiac glycosides severe disease activity). Anticoagulants prescribed for thromboembolic syndrome.

In the first months after discharge from hospital, patients with a history of myocarditis should be supervised; necessary to limit physical activity.

Prognosis depends on the form of the disease and its severity. When myocarditis Abramov-Fiedler, septic and diphtheria myocarditis prognosis for life unfavorable. Other forms of myocarditis, acute and subacute not less than 1/3 of the cases end in a complete recovery; the remaining patients in the observed outcome of cardio , the location and extent of which depends on the state of the heart functions.

Prevention is the prevention and timely effective treatment of infectious diseases. Necessary readjustment of foci of chronic infections - treatment of chronic tonsillitis, periodontitis, tooth decay.

In the prevention of drug and serum myocarditis crucial rigorous justification indications for the use of sera and medicaments based contraindications, especially in the presence of a history of allergies.