Typically, myocarditis develops as a complication of various pathologies and their frequency of occurrence is unknown. For example, when a diphtheria disease is found in 30% of patients, and the mortality rate in this case the nature of cardiac complications reaches 55%. Diagnosis of myocarditis with SARS observed in almost 15%.
What it is?
Myocarditis - is cardiac disease, namely, inflammation of the heart muscle (myocardium). The first studies of myocarditis, carried out as early as 20-30 years of XIX century, because modern cardiology has extensive experience in the diagnosis and treatment of this disease.
Myocarditis is not "tied" to a particular age, diagnosed as in the elderly, and children, and yet most often is seen in 30-40-year-olds: at least - men more often - women.
History of research
The beginning of the study of inflammation of the heart muscle can be attributed to the first quarter of the XIX century, the first time it mentions J.N. Corvisart. The term "myocarditis", and the concept of myocarditis is an inflammatory lesion of the myocardium first proposed I.F. Soberheim in 1837. In 1900, A. Fiedler, based on clinical data and the results of the autopsy, described the severe idiopathic myocardial injury and justified the concept of primary myocarditis.
Studies carried out by different scientists until 1918 We showed the possibility of myocarditis due to infectious diseases, especially influenza and other respiratory infections. Gradually acquired a diagnosis of myocarditis is very widespread, and up to 1930 it We used to refer to pathological processes in myocardium observed with most of the heart disease. As a chronic myocarditis addressed even changes in the myocardium in patients with coronary artery disease and hypertension.
In the 1930s, there is a number of studies, including the work of G. F. Lang, which indicated that many heart diseases, inflammation in the myocardium is absent, and are predominant degenerative changes. Due to this work unreasonably popular diagnosis of myocarditis disappears and is replaced by the term "myocardial dystrophy". Until the 1950s, the term myocarditis treated only in connection with rheumatic fever and diphtheria. The diagnosis of myocarditis again won the right to life since the Second World War, after the publication of I. Gore and O. Saphir results of postmortem studies in which the authors found on autopsy in 4-9% of cases of inflammatory changes in the myocardium, and it turned out that a considerable part of the deceased suffered a viral or rickettsial at one time disease.
The most active research of inflammatory diseases of the heart began in the 1980s with the introduction in clinical practice of diagnostic transvenous myocardial biopsy.
Causes of myocarditis
The most common cause of myocarditis - virus infection organism, fungi and bacteria. A particular group of microorganisms that provoke the development of the disease does not exist: it may be It caused by a wide variety of simple but at the same viral etiology is considered to be the most common and justified.
Infectious etiology myocarditis (pathogens):
- viral infections (infectious mononucleosis, measles, cytomegalovirus, hepatitis B and C, polio, influenza, measles, HIV);
- fungi (candidiasis, aspergillosis, coccidioidomycosis;
- bacterial infections (salmonellosis, diphtheria, meningitis, staphylococcal and gonococcal infections).
Myocarditis also tend to develop on the background of autoimmune diseases (systemic lupus erythematosus, rheumatoid arthritis, rheumatism), toxic poisoning low-quality alcoholic beverages, chemical intoxication, parasitic invasion.
Classification
Myocarditis may vary etiology, clinical manifestations and consequences:
- Chagas disease develops due to the simplest organisms - trypanosomes. Thus there is extensive myocarditis usually occurs several years after infection. The disease is preferably chronic, exacerbation can occur only in extremely rare cases. The disease is characterized by progressive heart failure and arrhythmia; they in the absence of an adequate therapy lead to death.
- Giant cell myocarditis is unclear origin. In this form of myocardial reveal multinucleated giant cells, which causes a rapidly progressive fatal heart failure. This myocarditis diagnosed very often, it develops in adults and often occurs with such diseases as thymoma, systemic lupus erythematosus, hyperthyroidism.
- Myocarditis caused by Toxoplasma is a rare form of the defeat of the heart muscle and develops most often in young people with weak immune systems. For disease characterized by heart failure, arrhythmias, conduction abnormalities.
- Radiation myocarditis occurs due to ionizing radiation. They lead to a variety of acute (less often) and chronic (mostly) disruption of the heart. Together with this form of myocarditis often develops myocardial fibrosis.
- Lyme disease - a disease caused by tick-borne relapsing fever. Its typical symptom is impaired heart conduction. Often this form is accompanied by pericarditis, left ventricular dysfunction.
- Bacterial myocarditis are quite rare and are caused mainly sticks Staphylococcus aureus or Enterococcus. This form of the disease affects the valve ring and the interventricular septum. There is also a bacterial myocarditis with diphtheria (25% of patients), as its serious complications and cause of death. In diphtheria toxin produced specific preventing protein synthesis. It was he who promotes the expansion, sagging of the heart impairs its contractility. Patients are assigned antitoxin and antibiotics.
For any variety of myocarditis characterized by different forms: acute, subacute and chronic (recurrent). The type and shape can be completely determined only cardiologist after a physical examination.
developmental stage
Viewed inflammatory process can take place in various ways:
- Galloping. Myocarditis manifested cardiogenic shock and severe impairment of left ventricular work. Against the background of such a defeat, there are numerous pockets of acute inflammation, in some instances, observed the destruction of cardiomyocytes. If qualified medical assistance in the fleeting myocarditis will be provided on time, it is possible to recover and complete recovery of tissues.
- Acute. A typical manifestation of this form will be considered inflammatory heart failure to active background border myocarditis. The patient should be provided adequate health care, but even in this case, the full restoration of tissue will occur.
- Chronic active. Myocarditis combines all of the above symptoms, the progression of the pathological process is accompanied by a cardiomyopathy. Even after the passage of a full course of treatment centers of inflammation persist and tissue fibrosis specialists discover and giant cells.
symptoms
Manifestations of myocarditis depends on the volume of damaged myocardial areas disturbed contractile function of the heart and its ability to generate electrical impulses, aggressiveness and toxicity of microorganisms, immune response system. The pathological process is characterized by non-specific symptoms that can occur in many diseases.
The symptoms of myocarditis include:
- Pain in the joints.
- lowering blood pressure.
- Pain syndrome in the cardiac region (cardialgia) which is not relieved by nitroglycerin.
- Violation of the general condition: fever; weakness, drowsiness; decreased performance; irritability; excessive sweating.
- Heart failure (impaired function reduction): myocardial hypertrophy (thickening of the heart muscle); intracardiac extension of the cavities; increasing organ boundaries; pale skin with a Crocq's disease (bluish nasolabial triangle, phalanges); dyspnea on exertion and rest; swelling of the neck veins; swelling of the lower extremities.
- Cardiac arrhythmias (excitation and deterioration of the function) - tachycardia, extrasystoles, atrial fibrillation.
With the progression of myocarditis formed congestive heart failure, left and right ventricle, which greatly impairs the quality of life of patients, and severe arrhythmias may lead to death outcome.
Diagnostics
Methods for diagnosis of myocarditis:
- blood cultures and urine tests to detect viral pathogens ailments;
- blood tests: general and immunological;
- electrocardiogram, showing the correct heart rate;
- myocardial biopsy, which helps determine the quantitative and qualitative loss kardiomitsitov (myocardial cells);
- echocardiogram showing violations of myocardial function and the presence of thrombosis;
- X-ray examination of the chest, with which you can quickly identify the increase in heart size.
By binding diagnostic items also relates physical examination, which consists in listening to the complaints of the patient, as well as superficial examination - listening to heart rate with a stethoscope, identification of edema, swollen veins, audition systolic noise.
infarction treatment
In the acute phase of the disease the patient is subject to compulsory hospitalization, regardless whether there was for the first time this disease or another escalation as rheumatic myocarditis. The patient in the first place need to limit physical activity - prescribed bed rest. These activities are aimed at reducing the burden on the heart and compensation of cardiac activity.
An important component of treatment infarction - diet №10 table assigned by Pevzner, which is useful in the majority of cardiac diseases, particularly such power:
- fluid intake restriction
- a reduced amount of sodium chloride
- also limited consumption of baked goods, fried foods, meat, smoked.
Treatment is aimed at all the links of the disease: to eliminate the pathogen, reduce inflammation (pathogenetic therapy), elimination of symptoms (symptomatic treatment).
pathogenetic treatment
Eliminate inflammation in the myocardium, you can use:
- nonsteroidal antiinflammatory drugs (NSAIDs) used for mild to moderate flow. Eliminates myocardial edema, pain form at significantly decreases or disappears completely pain syndrome. Multiplicity supplementation determined by the physician, taking into account the individual characteristics of the disease. Examples of drugs: ibuprofen, Voltaren, Diclofenac, Ibusan, Nurofen.
- glucocorticoids - hormones (. prednisolone metipred etc.) prescribed for severe disease, and autoimmune lesions, since these drugs have an immunosuppressive action. Anti-inflammatory effect is realized by suppressing the synthesis of antibodies.
- antihistamines.
The duration of therapy of NSAIDs and hormone determined by the result of repeated tests: in biochemical assays and general signs of inflammation disappear.
etiological treatment
Antibiotics, antivirals, antiprotozoal agents is carried out in cases of suspected presence in the body of the corresponding pathogen. In this case, it is sure to sanitize all chronic infection in the body: abscesses, carious teeth, sinusitis, adnexitis, prostatitis and so on.
When prescribing antibiotics, it is desirable to determine the sensitivity of the pathogen to it, though at first these drugs are prescribed empirically - apply broad-spectrum antibiotics.
Autoimmune or allergic myocarditis use hormones.
symptomatic treatment
It depends on the presence of accompanying pathologies, and on which complications developed due to myocarditis. Most often, patients should be the appointment of antiarrhythmic drugs and therapies aimed at dealing with symptoms of heart failure. The patients also needed myocarditis prevention of thromboembolic complications, which are assigned anticoagulants (Clexane, Fraksiparin) and antiplatelet (Plavix Egitromb).
Myocarditis duration of treatment depends on the severity of the disease, presence of concomitant diseases and the effectiveness of therapy. On average, patients treated for six months, but in some cases, medication support they need much longer. People with a history of myocarditis should be followed up by a cardiologist, and every 3 months to be screened.
metabolic therapy
During treatment should support the myocardium, so doctors prescribe drugs that stimulate the metabolism of the heart and improves its nutrition. The purpose of these drugs - to facilitate the recovery of the heart muscle. These drugs include vitamins, ATP, riboksin, mexicor.
potassium drugs also contribute to the restoration of myocardium, intracardiac improve conductivity, prevent the development of arrhythmias.
Duration of treatment infarction in the best case, is 4 months, but it's recommended rehabilitation after completion of the course. On average, the treated myocardium 6-7 months, and in severe cases - up to a year.
Forecast for life
When myocarditis prediction is unfortunately very variativen from complete recovery to death. On the one hand, often hidden myocarditis progresses and ends with absolute recovery. On the other hand, the disease can lead for example to Cardiosclerosis, accompanied by overgrowth of connective myocardial scar tissue, deformation of the valve and replacement of myocardial fibers, which then leads to sustained cardiac arrhythmias and conductivity. Among the likely consequences of myocarditis include also a chronic form of heart failure that can cause disability and even death.
Because after hospitalization the patient with myocarditis is still under medical observation for a year. it also recommended that the spa treatment in cardiology offices.
It is mandatory to observe patient, suggesting check-up 4 times a year, laboratory blood tests (including biochemical analysis) and urine, as well as ultrasound of the heart - every six months, a monthly pass ECG. It recommended as regular immunological studies and test for the presence of viral infections.
preventive measures
Not to think about how to treat myocarditis, it is worth to take care of their health. For prevention measures include:
Preventive measures for the prevention of disease
- full and prompt treatment of infections;
- rejection of bad habits;
- a general rise in living standards;
- proper nutrition, hardening, the use of vitamins;
- isolation of patients;
- healthy lifestyle;
- informed the appointment of vaccines, antibiotics and adherence to the rules of their reception.
Variativen prognosis of myocardial diseases - it may end as a complete recovery, and lethal. Therefore, when hospitalization with severe, even after the end of treatment, patients should be observed at the cardiologist and undergo fixing sanitary-resort treatment.
