Myocarditis

Myocarditis is an inflammatory lesion of the heart muscle. Etiology, pathogenesis. Distinguish myocarditis: rheumatic, infectious (infectious-allergic, para- and metainfectious), associated with tonsillar, viral, septic, rickettsial and other infections; Allergic (medicinal, serum, postvaccinal, with bronchial asthma, etc.); Myocarditis with collagenoses, parasitic infections, sarcoidosis, trauma, burns, exposure to ionizing radiation; Idiopathic myocarditis Abramov - Fiedler of an unknown etiology. The leading role in the pathogenesis of most forms of myocarditis belongs to various allergic and immunological changes.

Symptoms, course. Infectious allergic myocarditis (the most common form of non-rheumatic myocarditis) begins in contrast to rheumatic, usually on the background of an infection or soon after it; There is malaise, pain in the heart, sometimes stubborn, palpitations and "interruptions", shortness of breath, in some cases mild joint pain. Body temperature is often subfebrile or normal. The onset of the disease may be less than symptomatic or latent. The degree of severity of symptoms in a large sea is determined by the prevalence and severity of the progression of the process. With diffuse forms, the size of the heart increases relatively early. Important, but not permanent signs of myocarditis are cardiac arrhythmias (tachycardia, less often bradycardia, ectopic arrhythmias) and intracardiac conduction, and also presystolic, and in later stages proto-diastolic rhythm of the gallop. Short functional systolic murmur at the apex of the heart or at the fifth point and muffling of the tones are not reliable signs of myocarditis, while the disappearance of functional systolic noise during treatment due to the cessation of prolapse of the mitral valve leaf, as well as the restoration of sonority of heart sounds, Improvement of myocardium.

Idiopathic myocarditis is characterized by a heavier, sometimes malignant course with the development of cardiomegaly (due to pronounced dilatation of the heart), severe rhythm and conduction disorders, heart failure; Often near-wall thrombi in the cavities of the heart with thromboembolism in the large and small circles of the circulation.

In myocarditis associated with collagen diseases, viral infection (viruses of the Coxsackie group, etc.), concomitant pericarditis often develops. The course of myocarditis can be acute, subacute and chronic (relapsing). On ECG-various disorders of heart rhythm and conduction; In the acute stage of myocarditis, there are usually signs of a change in the myocardium, sometimes reminiscent of ischemic (in the absence of angina!). Laboratory signs of inflammation may be absent. Differential diagnosis should be carried out with coronary heart disease (especially in the elderly), myocardial dystrophy, cardiomyopathy, pericarditis.

Treatment. The regime is usually bed rest. It is advisable early combination of glucocorticoids (prednisolone, starting at 20-30 mg / day, in decreasing doses, etc.) with non-steroidal anti-inflammatory drugs in the following daily doses: acetylsalicylic acid 3-4 g, amidopyrine 1.5-2 g, butadione -0,45-0,6 g, ibuprofen (brufen) - 0,8-1,2 g, indomethacin - 75-100 mg. With heart failure - Celanide, digoxin (0.25-0.5 mg / day) and other cardiac glycosides, taking into account the increased sensitivity of patients with myocarditis to glycosides. Diuretics - furosemide (lasix) at 0.04 g per day, etc. Antiarrhythmic drugs (novocainamide 1-1.5 g / day, etc.). Means that improve metabolism in the myocardium: potassium orotate (1 g per day), methandrostenolone (0.005-0.01 g per day), vitamins B (thiamine chloride, riboflavin). With prolonged flow, quinoline preparations-delagil for 0.25 g / day, etc., are shown.

The prognosis for para- and metainfectious, medicinal, parasitic myocarditis is favorable in most cases. The prognosis is worse for myocarditis associated with collagen diseases, and especially with idiopathic myocarditis.