The symptoms and treatment of myocarditis
Myocarditis is an inflammation of the heart muscle (myocardium). The disease can occur due to exposure to infectious agents, toxins and as allergic or autoimmune reactions. Myocardial inflammation can be a symptom of different diseases and distinct disease. Very often it occurs due to rheumatism, one manifestation of which is on a par with pericarditis and endocarditis. Myocarditis can be acute and chronic; the acute form often transformirovalsya in cardiomyopathy.
Pathology is characterized by various symptoms that can appear bright or have a latent period. The disease diagnosis is not difficult only in the case when after a viral infection in a patient showing signs of acute failure of the heart. With the erased clinical picture to put the correct diagnosis is quite problematic.
Recently, the disease affects young people of working age (30-40 years). Myocarditis leads to a decrease in the pumping function, circulatory disorders of cardiac rhythm and conduction. This entails serious consequences: disability and even death.
The content of the article:
Myocarditis heart – what is it?Myocarditis is an active process of inflammation in the myocardium, in which there is necrosis and degeneration of cardiomyocytes (muscle cells of the heart). Thus pathological changes in the heart in myocarditis differ from changes that occur during a heart attack. Cardiomyocytes die and undergo a process of fibrosis. The appearance of inflammatory infiltrates can provoke any immune cells, but the cause of this inflammation is often an external factor.
Concerning the statistics of myocarditis, specific figures to designate quite difficult. The fact that the disease is often hidden flows and is not diagnosed by doctors. Long-term chronic inflammation leads to the fact that a person develops a dilated cardiomyopathy. And it occurs many years after exposure to the etiological factor, followed by the myocarditis.
Routine autopsy allows to detect myocarditis in only 1-4% of cases. With regard to European countries and North America, thereviral infection is considered to be the leading cause of the development of myocarditis. Damage to the heart muscle occurs according to various estimates, in 5% of cases after all viral infections. Thus severe cardiac pathology observed in 0.5-5.0% of cases.
Increase risk of development of myocarditis have an additional impact factors such as child bearing, age of the person (most often myocarditis in infants and adolescents), as well as time of year.
The mechanism of disease development at the moment actively studied. Scientists believe that the viruses have an effect on antigens, sent by cardiomyocytes, in the end, it is their immune cells perceive as foreign and start to destroy it. So developed the immune cell response.
More often lead to myocarditis enteroviruses, influenza virus, Coxsackie virus A and B. From 25 to 40% of HIV-positive people have signs of disorders in the heart, and only 10% manifested any symptoms.
A growing body of evidence regarding the fact that myocarditis can develop after a long time after undergoing radiotherapy and acts as a remote its complications. The artery and heart valves, and the myocardium can be damaged even after many years after exposure. Therefore, modern radiation therapy, in consideration of this fact should be made so that people could avoid this distant of heart problems.
Causes of myocarditis
The reasons for the development of myocarditis can be of different acute viral infections and bacteria. The appearance of it contribute to the flu and measles, rubella, varicella, diphtheria, scarlet fever, pneumonia, sepsis and so on. What viruses are the most common cause of this disease. It is proved that during virus outbreaks, the incidence of myocarditis increasing dramatically. It is noteworthy that the cause of myocarditis there may be two or more different infections. One of them, most often, is the condition for the destruction of the heart muscle, and the second is its immediate cause.
In addition to infection, myocarditis can be caused by poisoning and disorders of the immune system (including the introduction of sera and the intake of certain medications). The etiology of some myocarditis (idiopathic myocarditis Abramov-Fiedler) is still not established.
People suffering from myocarditis, no recommended physical activity, as they can exacerbate the disease.
The symptoms of myocarditis
The symptoms of myocarditis depend on how damaged is the myocardium, where it is localized inflammatory process, how strong is it and how is progressing rapidly. In any case, suffers contractile function of the heart muscle, has cardiac arrhythmias. If the precipitating factor is infection or Allergy, myocarditis manifests immediately after the disease. Rheumatic myocarditis has a different symptoms. Not eliminated latent course of the disease.
The symptoms of viral and infectious-toxic myocarditis manifested in severe intoxication; infectious-allergic myocarditis signs of inflammation of the myocardium occur in a couple of weeks after the exacerbation of chronic diseases; in case of poisoning (serum and drug myocarditis) the lesion appears after 12-48 hours after the administration of serum or medication.
Infectious-toxic myocarditis is often preceded by a prodromal phase with symptoms resembling the flu. Perhaps the appearance of lesions on the skin and the appearance of pain in muscles and joints. For children especially dangerous is the Coxsackie virus.
Sometimes myocarditis has no symptoms and can only detect it after ECG examination.
Common symptoms of myocarditis are:
- Unreasonable weakness;
- Shortness of breath, aggravated by physical exertion. Although sometimes it appears and at rest;
- You may experience coughing and a feeling of heaviness in the right hypochondrium;
- To Express the characteristic of myocarditis swelling in the legs and reducing the volume of urine;
- Pain in the heart. They can occur according to the type of disease and may have aching in nature. They often bother people for a long time and are not associated with physical activity;
- Palpitations or work with interruptions – these symptoms indicate existing heart rhythm disorders. Patients complain of the fact that they experience a sense of paralysis or heart failure;
- Body temperature remains within normal limits, although it is possible to increase to subfebrile level;
- People often suffer from excessive sweating;
- Sometimes there is pain in the joints;
Blood pressure is often below normal;
- The skin is pale, often has a bluish color. This is especially noticeable onthe tips of the fingers, earlobes, tip of the nose;
- As for pulse, it can be power and slower;
Dilated neck veins indicate a pronounced heart failure.
Heart increased in size, even small foci of infiltration in the body can cause the development of arrhythmia and lead to death of the patient. Despite the fact that symptoms of myocarditis there are many, often only 1-2 of them, and in 1/3 of the patients signs of cardiac pathology are absent.
There are the following variants of the course of myocarditis, acute myocarditis, severe and mild, recurrent myocarditis and chronic myocarditis.
Types of myocarditis
Myocarditis can vary in etiology, clinical manifestations and consequences:
- Bacterial myocarditis are quite rare and are caused predominantly sticks of Staphylococcus aureus or enterococci. This form of the disease affects the valve ring and interventricular septum. Bacterial myocarditis occurs also in diphtheria (25% patients), being its major complication and frequent cause of death. In diphtheria produces a specific toxin that prevents protein synthesis. It contributes to the expansion, sagging of the heart impairs its sacramenot. Patients are assigned antitoxins and antibiotics;
- Chagas disease develops due to protozoa – trypanosomes. While there is extensive myocarditis usually occurs several years after infection. The disease is mostly chronic, exacerbation may occur only in extremely rare cases. The disease is characterized by progressive heart failure and arrhythmia; it is they who, in the absence of adequate treatment lead to death;
Myocarditis caused Toxoplasma, is a rare form of defeat of the heart muscle and it develops most often in young people with weak immune systems. For the disease characterized by heart failure, arrhythmias, conduction disturbances;
Giant cell myocarditis has a mysterious origin. In this form in the heart muscle detect multinucleated giant cells, which causes rapidly progressive fatal cardiac failure. This myocarditis is diagnosed infrequently, it develops in adults and often occurs together with diseases such as thymoma, systemiclupus erythematosus, thyrotoxicosis;
- Illness Lima – a disease caused by tick-borne relapsing fever. Its typical symptom is a violation of cardiac conductance. This form is often accompanied by pericarditis and failures of the left ventricle;
- Radiation myocarditis caused due to ionizing radiation. It leads to various acute (rarely) and chronic (predominantly) the human heart. Together with this form of myocarditis often develops fibrosis of the myocardium.
Complications of myocarditis
Complications of myocarditis are manifested in sclerotic lesions of the heart muscle, resulting in the development of micardisbuy cardio.
Acute myocarditis severe quickly leads to the formation of the patient's heart failure and arrhythmias. This, in turn, often causes sudden death.
The diagnosis of myocarditisThe diagnosis of myocarditis causes certain difficulties. They are not only due to the latent course of the disease, but doctors lack clear criteria for identifying the pathology.
The main activities that are done to detect disease, the following:
- Clarification of patient complaints;
- Conducting physical diagnosis, during which it's possible to detect various heart disorders, from tachycardia and ending with heart failure. In addition, the patient may be diagnosed swelling of the extremities, increase of neck veins, congestion in the pulmonary system, etc.;
- An ECG, the results of which can judge the heart rhythm disturbances, conduction and excitability of the heart. Any specific for myocarditis signs to be detected on the ECG will fail;
- Holding The Echo. This technique will allow to detect such diseases of the heart muscle, as the increase in its cavities, low contractility, and diastolic dysfunction;
- Implementation of x-ray light allows to diagnose the presence of stagnant phenomena in the respiratory organs and also gives the ability to determine the size of the heart;
- To identify the type of agent, which led to the development of myocarditis, can be carried out the TANK-the blood culture or in place of the fence for performing PCR;
- MRI of the heart with the use of contrast material allows you to see the process of inflammation, to detect edema in the cardiac muscle. It is quite informative method that produces results in 75% of cases;
- The introduction of the catheter in the heart cavity for suction biopsy of the myocardium for further histological examination allows to determine the myocarditis only 37% of cases. This is because the inflammation may be centered anywhere the heart muscle, and not where were extracted biopsy;
The zone of necrosis and inflammation can be determined by radioisotope studies of the heart (PET-CT).
The treatment of myocarditis
The treatment of myocarditis, regardless of cause, it triggered, in General, has similar elements. This is because any myocarditis is inflammation of heart muscle and there is inadequate response of the immune system to inflammation, which leads to the death of cardiomyocytes and development miotaticheskogo cardiosclerosis. Listed a set of factors determine the tactics of therapy.
Hospital treatment may last from 3 weeks to 2 months, depending on the state of health of the patient.
At this time you must implement three global goals:
- To carry out medical correction;
- To eliminate pockets of chronic infection;
- To start the physical rehabilitation of the patient.
This includes receiving immunomodulators, means for the normalization of metabolic processes.
As the basis for the development of myocarditis is becoming an infection is already on the severity of inflammation can be suspected, bacteria or viruses provoked cardiac disorders. Thus, when bacterial myocarditis inflammation occurs acutely, but can be cured with antibiotics. In addition, bacteria rarely cause granitization inflammatory process in the myocardium.
If it is established that myocarditis is bacterial in nature, then the patient is prescribed a course of antibiotics. Mostpreferred are drugs of cephalosporin group. When the illness became chronic, it is shown that repeated courses of antibiotic therapy with the use of drugs from the group of fluoroquinolones and macrolides. Their admission mandatory Supplement of exogenous interferon and inducers of endogenous interferon (Viferon, Neovir). Preparations of exogenous interferon is particularly effective in order to combat myocarditis viral nature.
Antihistamine and anti-inflammatory drugs are prescribed for the relief of inflammation in the heart muscle itself. This short course is the patient takes NSAIDs (Diclofenac, Indomethacin, etc.), as well as anti-Allergy drugs - Suprastin and Tavegil. For a period of up to six months patients recommend receiving Delagila.
The next stage of treatment is a therapy with steroids (Dexamethasone and Prednisolone). However, these drugs are not all patients, but only those who have in the inflammatory process prevalent autoimmune factor. Prednisolone prescribed a short course. Preferred pulse therapy this hormone with its intravenous administration. Although it is possible oral ingestion throughout the week, with subsequent withdrawal within thirty days. While the majority of patients noted improvement with disappearance of edema, stabilization of heart rhythm. However, the treatment with steroid hormones always associated with certain complications, what to remember the doctor.
So, the patients increases the risk of Contracting other infections, because the immune system refuses depressed. Any SARS can trigger a recurrence of myocarditis. Therefore, if to diseases of the heart muscle caused a viral infection before beginning treatment with hormonal therapy is necessary to conduct antiviral therapy.
From the very first days after diagnosis, patients are administered drugs disaggregants (Trental, Aspirin Cardio, etc.), blood thinners. This is due to problems in circulation caused by fibrosis of the tissues of the heart muscle. To slow down the process of fibrosis of the myocardium allow the ACE inhibitors and antagonists of interferon.
As the cross-occurrence of autoimmune processes in myocarditis is almost regularity, the patients shown immune-modifying therapy. For this prescribed courses of plasmapheresis, repeated courses of pulse therapy of corticosteroids and interferon inducers.
With regard to the normalization of metabolism, it is important to carry out metabolic correction until the beginning of antibacterial or antiviral therapy. In addition, throughout the treatment, the patient should observe strict bed rest. Assignedpotassium (Asparcam, Potassium orotate, Panangin), Riboxin, ATP.
Symptomatic therapy depends on the severity of the clinical picture of the disease. So, to reduce swelling prescribe diuretics, etc.
While in the hospital, the patient is required rid of foci of chronic infection. It is treated sinusitis, tonsillitis, pulpitis, etc. it is Important to choose the best time to treat these diseases, during treatment did not deteriorate the General health of the patient.
After discharge, the patient required rehabilitation activities. It can be either in the sanatorium or at the district hospital. Ongoing treatment with Delagil and drugs-antiplatelet agents. Be sure to prescribe the aldosterone antagonists, ACE inhibitors, antagonists b-blockers.
The diet involves restriction of salt and fluid in the acute phase of the disease. Emphasis is placed on protein foods with a maximum intake of vitamins. The duration of therapy depends on the severity of the disease is from six months or more.
If the myocarditis had a latent period, then it is possible self-healing without the development of long-term complications. If the patient develops heart failure, the treatment is effective only in 50% of cases. Another 25% of patients cardiac function is stabilized. The remaining portion of patients with heart failure continues to progress.