Myocarditis - Causes, symptoms and treatment. MF.

Myocarditis is a focal or widespread inflammation of the heart muscle as a result of various infections, the effects of medications, toxins or immune processes that lead to damage to heart tissue cells and the development of heart failure. The true prevalence of myocarditis is very difficult to assess, as in most cases it occurs without vivid symptoms and usually ends in complete recovery. According to the data of pathoanatomical studies of the deceased, the prevalence of this disease varies between 1 and 4%.According to statistics of myocarditis, people of reproductive age are sick more often than 40 years. Women are more likely to have this disease than men, but the male half of the population is more susceptible to more severe forms of myocarditis that occurs with severe complications.

Causes of myocarditis and its form.

All causes that in one way or another can lead to the formation of inflammation in the heart muscle can be divided into 3 main groups. These are infectious and infectious-toxic causes. These include viruses: measles, infectious mononucleosis, adenoviruses, influenza viruses, infectious hepatitis and HIV.The direct harmful effect on the cell, they have by implanting inwards, thereby violating normal physiological processes. Of the bacteria that play a role in the development of myocarditis, we can distinguish the following: diphtheria bacillus, mycobacterium tuberculosis, streptococci, meningococci and gonococci. Rarer forms: fungal lesions( aspergillosis, actinomycosis, candidiasis), parasitic infestations( toxoplasmosis, schistosomiasis, echinococcosis).

Allergic group: as a result of exposure to drugs( sulfonamides, cephalosporins, antidepressants), systemic connective tissue diseases. All this activates the immune system of the body in the wrong mechanism, which, trying to suppress inflammation, takes its organs and tissues for a pathogenic object and attacks them.

Toxic effects( drugs, alcohol, thyroid disease and diabetes) have a direct effect on the heart muscle, leading to cell death.

Symptoms that occur in myocarditis.

With the flow, several forms of myocarditis are distinguished depending on the onset of symptoms and the duration of their existence. Acute myocarditis is characterized by acute onset and severity of clinical manifestations. Subacute myocarditis is characterized by a less vivid clinical picture, moderate changes in laboratory tests. Chronic myocarditis is characterized by a prolonged course with periods of exacerbation and complete disappearance of all symptoms. Also three degrees of severity of myocarditis are distinguished: light, medium-heavy and severe form.

Symptoms of myocarditis do not have any specific features, according to which it would be possible to say with 100% certainty that this is the pathology. But in most cases, the relationship of heart disease to infection or other of the above listed reasons can be traced. The disease most often develops in a few days( less often - weeks) after a viral infection and in most cases it is asymptomatic. Most often( 60% of cases), patients begin to feel pain in the region of the heart, which usually come from near the nipple and can spread to the entire chest area. The pains are usually of a pressing or piercing nature, prolonged in time and do not depend on physical effort or stress, that is, they can arise at rest.

Shortness of breath is the second most common symptom of myocarditis. Its appearance is associated with a declining contractility of the left heart. It usually occurs with severe physical exertion, with a mild form of myocarditis or even in rest - with moderate and severe forms. Dyspnea may increase when the patient takes a horizontal position.

Fast heart rate is noted by 47.3% of patients with myocarditis. Interruptions in the work of the heart, dizziness and fainting arise as a result of rhythm disturbances and are the primary causes with which patients are treated. With prolonged course of myocarditis, edema on the legs may appear, which are the result of insufficient work of the heart.

If you have started to notice any of these symptoms in yourself and you recently had a viral infection or are abusing alcohol and drugs, contact your local doctor.

Diagnostic measures.

You should tell your doctor: did you have a cold, was there a fever, joint or muscle pain, a rash on the skin. It is also necessary to report whether you are concerned about pain in the heart or chest area and what this pain is related to( physical activity, eating or pains arise at rest).You must necessarily ask if you have increased fatigue recently, whether there are night attacks of suffocation or heart palpitations. Then the doctor will need to look and listen to you.

From laboratory diagnostic methods in the general blood test, there will be an increase in the number of leukocytes and an acceleration of the ESR.However, these indicators may not be permanent and depend on many circumstances. In some patients, the level of myocardial enzymes( CK, MB-CK, LDH) may increase in the biochemical blood test, the degree of increase of which reflects the severity of the inflammatory process in the tissues of the myocardium.

In some controversial situations, to determine the cause of myocarditis and in the presence of certain symptoms, it is necessary to perform an analysis on the detection of antibodies to cardiotropic viruses, a fourfold increase in which is of diagnostic significance.

Instrumental diagnostic methods include: an electrocardiogram and a 24-hour Holter ECG monitoring. Myocarditis can cause abnormalities on the ECG.Various rhythm disturbances may occur, such as sinus tachycardia or bradycardia, and other types. When performing EchoCG in patients with a low-symptom or asymptomatic course of myocarditis, changes may be absent or may reveal minor quantitative changes in blood volume. With the expressed degree of myocarditis with the development of heart failure, the contractility of the heart and the volume of blood that it discharges drop.

X-ray examination allows to determine the degree of expression of the increase in heart volume and signs of stagnant phenomena of blood in the lungs. In very rare cases and for special indications, myocardial biopsy is performed. The final diagnosis can be established only after this invasive method is carried out.

When diagnosing "myocarditis," it is necessary to exclude diseases that occur with secondary damage to the heart, that is, those diseases that, due to their complications, lead to the development of an inflammatory process in the heart.

For differential diagnosis of non-rheumatic myocarditis, endocrine, metabolic and general systemic diseases should be excluded as the main cause of cardiac muscle damage. Very often pain in the heart is taken for angina pectoris, I would like to list the main differences. Patients with myocarditis usually indicate a recent infection, patients have predisposing factors to the development of coronary heart disease( smoking, high blood pressure, metabolic disorders), angina is characterized by a positive effect of taking nitroglycerin. For myocarditis, which develops in young children, it is necessary to take into account the possibility of developing congenital disorders( eg, neuromuscular diseases, endocrine pathology, congenital abnormalities of vascular development).

For more detailed analysis of the cause of endocarditis, it is necessary to get a consultation of a rheumatologist, an ENT doctor, an infectious disease specialist, a cardiosurgeon.

Treatment of myocarditis.

During treatment it is necessary to solve several basic points: it is necessary to prevent irreversible expansion of the heart chambers, to minimize the risk of developing chronic heart failure. When suspected of myocarditis, all patients should be hospitalized. It is necessary to comply with bed rest, the duration of which depends on the degree of myocarditis. If the degree is severe, the risk of complications should be treated in the intensive care unit. It is necessary to observe the diet during treatment and for a long time after with the restriction of liquid and salt.

Drug treatment in patients with myocarditis should be aimed at eliminating the causative factor and directly treating the symptoms of myocarditis. It is also necessary to correct the immune system and eliminate possible further complications. Since in the vast majority of cases the cause of myocarditis is a viral infection, it is necessary to carry out antiviral therapy( polyclonal immunoglobulins, interferon alfa, riboverin) in the acute period of the disease at the height of the symptoms.

With the development of myocarditis against a background of bacterial infection, patients are shown to use antibacterial agents. Antibiotic prescribe taking into account the underlying disease. Of antibiotics, erythromycin, doxycycline, monocycline, penicillin, oxacilin are most often used. It is necessary to sanitize chronic foci of infection, which will favorably affect the outcome of myocarditis.

In severe forms of myocarditis with high activity, heparin is prescribed as a prophylaxis for thromboembolic complications. Antiarrhythmic drugs are used in patients with tachycardias and other rhythm disorders.

Surgical treatment is indicated for patients with persistent rhythm disorders that do not respond to conventional therapy. They are implanted with an external pacemaker, which, by generating the correct frequency of contractions, causes the heart to contract and ensure normal blood circulation.

After recovery, the frequency of a doctor's visit depends on the form of myocarditis. With focal or mild myocarditis, an observation is seen at the cardiologist once every 6 to 12 months. At the average - every 3 months, and with a severe degree, repeated hospitalization is necessary. It should be remembered that if you once suffered from myocarditis you need to avoid hypothermia, intense physical exertion, reduce the intake of table salt to 3 grams per day, if you catch shortness of breath and swelling on your feet, immediately consult a doctor.

Prophylaxis and prognosis.

Myocarditis can develop as a manifestation or complication of any infectious disease( primarily viral), so the prevention of myocarditis is reduced, mainly, to the prevention of these diseases. It consists in carrying out preventive vaccinations and vaccinations against those infectious agents that directly affect the heart( measles, rubella, influenza, poliomyelitis, diphtheria).All patients who have had sudden deaths or heart failure at a young age in the family should undergo a medical examination and an ECG study at least once a year. In addition to the survey, work associated with overloading or professional sports should be avoided.

With regard to the prognosis of myocarditis, the "three" rule operates: one-third of patients recover, one-third develops heart failure and a third of the condition deteriorates rapidly and can have lethal outcomes. So watch your health and do not be ill!

Doctor therapist Zhumagaziev E.N.