Myocarditis: Symptoms and Treatment

GENERAL

Today incidence of myocarditis is about 4-11% of the total number of cardiac diseases. The disease can occur in the following forms:

• acute accompanied by the rapid development, arrhythmia and heart failure, in some cases, result in death.
• galloping form It causes impaired left ventricular function, manifesting pronounced cardiogenic shock and destruction of cardiomyocytes (heart cells).
• chronic persistentIn which the left ventricle is preserved functionality in fully before the transfer of disease in active phase boundary myocarditis. For the initial phase of this form of the disease is characterized by the absence of severe symptoms, but can later develop heart failure, Get rid of that the patient is not always possible even after the inflammatory process.
• chronic active It combines the symptoms of acute and transient forms, at the same time distinguished by a high risk of cardiomyopathy. Local centers of inflammation may persist even after recovery, the disease also complicated by fibrosis (abnormal growth of connective tissue cells, accompanied by its scarring).

Chronic myocarditis occurs predominantly due to a lack of timely diagnosis and treatment of acute forms of the disease. The chronic course of the disease is recurrent in nature, sharpening on a background of viral diseases and other unfavorable factors. Myocarditis often affects women, but men usually suffer from more complex forms of the disease. The risk group includes people aged 30-40 years.

Thanks to modern diagnostic and treatment methods for severe miokradita, could result in death, there are now very rare.

CAUSES

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, rubella, Cytomegalovirus, hepatitis B and C, polio, flu, measlesHIV);
• mushrooms (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, Rheumatic disease), toxic poisoning low-quality alcoholic beverages, chemical intoxication, parasitic infestations.

CLASSIFICATION

There are several types of myocarditis:

• rheumatic myocarditis in adult patients differ relatively easy, virtually asymptomatic. Patients complain of mild pain in the heart, shortness of breath with an increase in physical activity, mild tachycardia, a slight decrease in blood pressure. Survey results show that the patient's heart has kept regular size or increased slightly, a soft systolic murmur is heard. Rheumatic myocarditis in children may be associated with impaired circulation, severe swelling of the myocardium with impaired functionality. In patients experiencing dyspnea, pale skin with frequent manifestation blue nasolabial triangle, jugular venous distention, severe pain in the heart, rapid pulse. In the absence of a timely and adequate treatment of the disease threatens to transform into myocarditic kardiosklerosis.
• allergic myocarditis It occurs when the immune system malfunction occurs, in which the body begins to attack the heart muscle. This side effect of allergy, the appearance of which is triggered by the reception of various drugs, vaccination, ingestion of toxins or infection, transplantation of organs. Depending on the size of myocardial injury patient feels a dull pain in the varying intensity of the heart, heart palpitations, shortness of breath, fatigue.
• infective myocarditis - the most common type of the disease, which manifests itself in the background of ingestion of a viral infection or shortly after recovery. The patient is present mild pain in the joints, as well as all the symptoms characteristic of myocarditis: disruption of the heart, pain, shortness of breath, a slight increase in temperature.
• idiopathic myocarditis Abramov-Fiedler - one of the worst forms of myocarditis that occurs on a background unexplained reasons, but often its origin is observed in patients suffering from autoimmune diseases. Also, the disease can occur as a consequence of untreated infectious myocarditis. Idiopathic myocardial often accompanied by severe symptoms such as heart failure, The formation of mural thrombi, tachycardia, pericarditis, pulmonary edema, Cyanosis, edema. The disease is divided into degenerative, infiltrative inflammatory, vascular and mixed types. In the most severe cases (against the background of the emergence of serious diseases), pathology has a rapid course and ends of life stop.
• tubercular myocarditis - a rare complication tuberculosisIn which tissue infarction appear nodules composed of lymphoid tissue. In addition to the classic symptoms of tuberculosis stream myocarditis tend to increase not only the right but the left heart.

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.

SYMPTOMS

Onset of the disease is often asymptomatic or with mild symptoms that the patient may be confused with signs of fatigue or beriberi. Myocarditis develops within 1-2 weeks - the end of this period, the patient has shortness of breath, severe weakness, decreased performance, sometimes - pain and aching joints, fever, puffiness. With increasing stress symptoms worsen, they are joined by a failure in heart rate.

The main symptom that causes patients to pay attention to the change of its status and make an appointment to see a doctor, is a pain in the left upper quadrant. Depending on the type and form of myocarditis its flow, it can be sharp or dull, aching. Heart pain is often accompanied by panic attacks, sweating, tremors in the hands and feet. Complicated by heart failure, myocarditis has an additional symptom - swollen veins in the neck.

DIAGNOSTICS

For a correct diagnosis of myocarditis and differentiation from other types of heart disease the patient is assigned to a series of laboratory and hardware survey.

Methods for diagnosis of myocarditis:

• blood tests: general and immunological;
• blood cultures and urine tests to detect viral pathogens ailments;
• myocardial biopsy, which helps determine the quantitative and qualitative loss kardiomitsitov (myocardial cells);
• electrocardiogram, showing the correct heart rate;
• X-ray examination of the chest, with which you can quickly identify the increase in heart size;
• echocardiogram showing violations of myocardial function and the presence of thrombosis.

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.

TREATMENT

In the diagnosis of myocarditis of any etiology patient is usually prescribed strict compliance with bed restAnd sometimes hospitalization in cardiology department to the full restoration of the physiological heart size and normalize the blood circulation.

Treatment includes restriction of fluid diet and low salt content, withdrawal symptoms, support of the metabolic processes, detection and therapy of foci of viral or bacterial infection. Pathogenetic treatment is receiving antihistamines and immunomodulating preparationsIn severe cases - glucocorticoid hormones.

After recovery, which is necessarily supported by the same methods that sipolzuyutsya in the diagnosis of disease, the patient is prescribed vitamin therapy with a predominance of potassium preparations riboksina, Cocarboxylase. Withdrawal symptoms include medications to help get rid of tachycardia, hypertension, heart failure and other clinical manifestations of myocarditis.

COMPLICATIONS

A long untreated or appearance comorbidities myocarditis fraught transition in myocardio cardio, as well as the occurrence of severe congestive heart failure and arrhythmia, can cause lethal Exodus.

PREVENTION

Preventive measures for the prevention of myocarditis:

• infection diseases prevention of viral and bacterial etiology;
• vaccination against epidemic diseases;
• regular baseline medical examination by a cardiologist at least 1 time per year.

Prevention of the disease also promotes adherence to a healthy lifestyle (sport, healthy and regular meals, adherence) and avoiding harmful habits.

FORECAST FOR RECOVERY

In asymptomatic myocarditis and malosimptomno great probability of spontaneous healing. With respect to other forms of the disease, then the outcome depends on the severity and degree of myocardial dysfunction.

In related heart failure in about one quarter of patients develop a chronic form of the disease with progressive symptoms, half of the observed complete recovery in the remaining quarters of cardiac activity is stabilized against the background of preservation of the main diagnosis.

In some cases, myocarditis calls for urgent heart transplantationAlthough the forecast is not very optimistic - very high risk of disease recurrence with subsequent rejection of the implant.

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