Congenital carditis
Myocarditis is a lesion of the heart muscle caused by inflammation. As shown by numerous observations, in children with myocarditis in the process are almost always involved at the same time, all three shells of the heart. Signs that testify to the involvement of other shells of the heart are negligible and smoothed by changes in the myocardium. This explains the wide use of the term "myocarditis", but it does not reflect the entire pathological process and its prevalence. In connection with the fact that, in fact, all the shells of the heart are affected, the term "carditis" is used.
In recent years, hereditary factors have attracted attention in the formation of carditis. The disease in such cases proceeds almost imperceptibly, with the development of heart failure only in the final. At the heart of congenital carditis , probably, is a genetically conditioned defect of antiviral immunity. Viruses can be transmitted from parents to offspring( "family" viruses), and then they cause latent( latent), chronic or slow infection.
The diagnosis of congenital carditis is considered correct if the symptoms of cardiac pathology are detected in utero or in the hospital. Congenital carditis is likely if all signs of this pathology occur in the first months of a child's life without a previous illness and( or) in the case of a mother's illness during pregnancy. Depending on the violation of the anatomical structure of the body( heart), congenital carditis is divided into early and late. An obligatory morphological sign of early carditis is excessive growth or disruption in the growth of elastic( fibroelastosis) or connective tissue( elastofibrosis) fibers of the endo- and myocardium. Late carditis does not have this feature. A large amount of elastic tissue in the heart indicates its damage at the 4-7th month of intrauterine development( early fetal period), when the fetal tissues respond to any damage by proliferation as a result of the multiplication of cells, which leads to the development of elastosis and fibrosis. With the defeat of the heart after the 7th month( late fetal period), an ordinary inflammatory reaction is formed, and fibroelastosis does not develop.
With early congenital carditis, an increase in heart size( cardiomegaly) with an expansion of the left ventricular cavity and a thickening of its muscular membrane is revealed. The inner membrane of the heart is also considerably thickened.
The first signs of congenital heart disease in both variants of early congenital carditis manifest for the first time 6 months of life( less often in the 2-3rd year).The child begins to lag behind in physical development from his peers, appear lethargic, pale, quickly fatigued when feeding. When examined at the doctor, an increase in the size of the heart( cardiomegaly), early developing heart hump( deformation of the chest) is revealed. When listening to the work of the heart determine the deafness of the heart tones, the absence of noise. Somewhat later, signs of heart failure, resistant to treatment, are added.
Additional methods of examining a child are ECG, chest X-ray, cardiac catheterization and angiocardiography. When X-ray examination of the chest, determine the shape of the heart. For fibroelastosis, the spherical or ovoid form of the heart is more typical, for postmiocardic elastofibrosis - trapezoidal. At the catheterization of the heart cavities and angiocardiography, there are signs of a violation of the contractility of the myocardium( muscle) of the left ventricle with a moderate increase in pressure in the pulmonary artery.
In late congenital carditis, two or all three cores of the heart are involved in the pathological process. Also affects the conduction system of the heart, which carries out a contraction of the heart muscle. The defeat of this system leads to the occurrence of various violations of the heart rhythm. Sometimes the blood vessels that feed the heart( coronary vessels) are affected, there is sclerosis of the heart muscle and a thickening of the muscular membrane( myocardium).A child with such a disease quickly becomes fatigued when feeding, excessive sweating appears. Beginning from the 3rd to 5th month after birth, the child begins to lose weight. Some children have changes in the central nervous system: seizures of sudden anxiety with increased dyspnoea and bluish staining of the skin, seizures, sometimes with loss of consciousness. Signs of heart damage include: moderate expansion of the heart, loud heart tones, less pronounced than with "early" carditis, heart failure, pathological noises when listening to the heart are absent. Quite often there are violations of the heart rhythm with increasing or decreasing heart rate.
In acute carditis, a laboratory blood test can produce results that are characteristic of the inflammatory process of the myocardium. In blood tests, accelerate ESR, increase the number of leukocytes, increase the level of proteins( a- and y-globulins).These changes in blood reflect a viral infection in the child's body. The most reliable confirmation of the disease is the isolation of the virus from the blood, nasopharyngeal mucus, feces, as well as the determination of a high content of antibodies against this virus.
Additional methods of examining a child are ECG, chest X-ray.
Treatment of carditis includes two stages: stationary( acute period or exacerbation) and polyclinic, or sanatorium( the period of maintenance treatment).It is necessary to carry out measures to eliminate the cause of the disease( the effect of drugs on the virus, the effect on the immune system of the body, the fight against cardiovascular failure).Carry out general plan activities and medication. The measures of the general plan include observance of the motor, food, drinking regimen.
In case of acute carditis it is recommended to limit the motor activity of the child within 2-4 weeks. The nutrition of the child during this period should be high-grade with sufficient content of vitamins, proteins, restriction of table salt, increased amount of potassium salts( raisins, dried apricots, figs).The drinking regime is determined by the amount of urine released per day: the baby is given fluids 200-300 ml less than the amount allocated to them. Treatment with antibiotics is carried out within 2-3 weeks. The main goal of this treatment is the prevention of various bacterial complications in young children. With extensive heart damage with the development of heart failure, with subacute onset of the disease( which is a harbinger of the transition of carditis into a chronic course), with cardiotherapy with a predominant lesion of the conduction system of the heart, hormonal drugs( prednisolone) are used. If, in spite of this treatment, the disease becomes chronic, then drugs such as delagil or plaquilin in combination with indomethacin or voltarenum are prescribed.
Simultaneously, cardiovascular failure is treated. Cardiac glycosides are used to improve the contractile function of the heart, for example, digoxin.
A great place for children with acute carditis and heart failure is given to diuretics. The specific drug should be selected only by the attending physician, since for this it is necessary to know the stage of heart failure, and the use of the wrong drug( which in most cases occurs during self-medication) can lead to adverse consequences.
Also used in the treatment of carditis are drugs that improve metabolic processes in the myocardium: panangin, riboxin, potassium orotate, vitamin B12 with folic acid, calcium pangamate, calcium pantothenate.
When chronic carditis should not be a long time to adhere to bed rest, since detenirovannost negatively affects the cardiovascular system.
Children with congenital carditis after discharge from the hospital, in which they spend an average of 1.5 months, come under the supervision of pediatricians and cardiothoriatologists. Doctors monitor the implementation of appointments and recommendations made in the hospital, and if necessary, carry out their correction. Such drugs, as digoxin and panangin, children receive a long time. It is necessary to constantly monitor the cardiologist with regular ECG monitoring( once every 3-6 months), chest radiography( once every 6-12 months and more often if suspected of exacerbating the disease).
Prophylactic vaccinations are contraindicated for all children with acute carditis for at least 3-5 years. With chronic carditis vaccination is contraindicated.