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Myocarditis – an inflammation of a muscular cover of heart (myocardium), is more often than rheumatic, infectious or infectious and allergic character. The course of myocarditis can be sharp or chronic. Sharp myocarditis is shown by short wind, cyanosis, hypostases standing, swelling of veins on a neck, heartaches, heartbeat, arrhythmias. Often development of myocarditis is preceded by the postponed infection (diphtheria, quinsy, scarlet fever, flu, etc.). Further a disease recurrence (is possible at rheumatic myocarditis), development of heart failure and tromboemboliya of vessels of various bodies.

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Myocarditis

Myocarditis – an inflammation of a muscular cover of heart (myocardium), is more often than rheumatic, infectious or infectious and allergic character. The course of myocarditis can be sharp or chronic. Sharp myocarditis is shown by short wind, cyanosis, hypostases standing, swelling of veins on a neck, heartaches, heartbeat, arrhythmias. Often development of myocarditis is preceded by the postponed infection (diphtheria, quinsy, scarlet fever, flu, etc.). Further a disease recurrence (is possible at rheumatic myocarditis), development of heart failure and tromboemboliya of vessels of various bodies.

Frequency of incidence of myocarditis is much higher statistical because of late diagnostics and latent forms when the disease proceeds is erased or benign. Signs of inflammatory process in a myocardium in 4–9% of cases are found only on autopsy (by results of pathoanatomical researches). From 1 to 7% of patients die of sharp myocarditis, at people of young age in 17-21% of cases it becomes the reason of sudden death. Myocarditis leads to development of heart failure and violation of a rhythm of heart that is the leading reasons of a lethal outcome. Myocardites meet more often at young people (average age of patients of 30 - 40 years) though the disease can arise at any age. Men get sick with myocarditis slightly less often than women, but to their thicket severe forms of a disease develop.

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Myocarditis reasons

Myocardites include big group of the diseases of a cardiac muscle of inflammatory genesis which are shown defeat and dysfunction of a myocardium. Various infectious diseases are the frequent reason of myocarditis:

The severe form of myocarditis can arise at diphtheria, scarlet fever, sepsis. The viruses causing myocarditis in 50% of cases possess a high kardiotropnost. Sometimes myocarditis develops at system diseases of connecting fabric: system red a wolf cub, rheumatism, vaskulita, rheumatoid arthritis, at allergic diseases. Also toxic influence of some medicines, alcohol, ionizing radiation can serve as the reason of myocarditis. The heavy progressing current distinguishes idiopathic myocarditis of the obscure etiology.

Myocarditis in most cases is followed by an endocarditis and perikardity, less often inflammatory process affects only a myocardium. Injury of a myocardium can arise at direct miokardiotsitolitichesky action of the infectious agent; under the influence of the toxins circulating in blood (in case of a system infection); and as result of allergic or autoimmune reaction. Quite often infectious and allergic myocardites meet.

The provocative moments of developing of myocarditis are sharp infections (more often virus), the centers of a chronic infection; allergoza, the broken immunological reactions; toxic impact on an organism (drugs, alcohol, drugs, ionizing radiation, at a thyrotoxicosis, uraemia, etc.).

The immune violations observed at myocarditis are shown by frustration of all links of immunity (cellular, humoral, a fagotsitoza). The infectious anti-gene starts the mechanism of autoimmune damage of kardiomiotsit leading to considerable changes of a myocardium: to dystrophic changes of muscle fibers, development of ekssudativny or proliferative reactions in interstitsialny fabric. Growth of connecting fabric and development of a cardiosclerosis is a consequence of inflammatory processes at myocarditis. At myocarditis pump function of a cardiac muscle considerably decreases that often has irreversible character and results in serious condition of insufficiency of blood circulation, violations of a warm rhythm and conductivity, serves as the reason of disability and a lethal outcome in young age.

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Classification of myocardites

Depending on the mechanism of emergence and development of myocarditis allocate the following forms:

  • infectious and infectious and toxic (at flu, viruses of group of Koksaki, diphtheria, scarlet fever, etc.);
  • allergic (immune) (serumal, infectious and allergic, transplant, medicinal, myocardites at system diseases);
  • toksiko-allergic (at a thyrotoxicosis, uraemia and alcoholic damage of heart);
  • idiopathic (obscure nature).

Myocardites are divided by prevalence of inflammatory defeat on diffusion and focal.

On a current distinguish sharp, subsharp, chronic (progressing, recuring) myocardites. On severity - easy, myocarditis of average weight, heavy.

On character of an inflammation allocate ekssudativno-proliferative (inflammatory and infiltrative, vascular, dystrophic, mixed) and alternative (dystrophic-nekrobiotichesky) myocardites.

In development of infectious myocarditis (as the most often meeting) allocate 4 pathogenetic stages:

  1. Infectious and toxic
  2. Immunological
  3. Dystrophic
  4. Miokardioskleroticheskaya

By clinical options (on the prevailing clinical symptoms) distinguish myocardites:

  • malosimptomny
  • painful or pseudo-coronary
  • dekompensatsionny (with blood circulation violation)
  • arhythmic
  • tromboembolicheskiya
  • pseudo-valvate
  • mixed
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Myocarditis symptoms

The clinical symptomatology of myocarditis depends on extent of damage of a myocardium, localization, sharpness and progressing of inflammatory process in a cardiac muscle. It includes manifestations of insufficiency of sokratitelny function of a myocardium and violation of a rhythm of heart. Infectious and allergic myocarditis unlike rheumatic begins usually against the background of an infection or right after it. The beginning of a disease can proceed malosimptomno or latentno.

The main complaints of patients - on strong weakness and fatigue, short wind at physical activity, pain in heart (aching or pristupoobrazny), violations of a rhythm (heartbeat, interruptions), the increased perspiration, sometimes joint pain. Body temperature usually subfebrilny or normal. Characteristic displays of myocarditis are increase in the sizes of heart, lowering of arterial pressure, insufficiency of blood circulation.

Integuments at patients with myocarditis pale, sometimes with a cyanotic shade. The pulse which is speeded up (sometimes urezhenny), can be arrhythmic. At the expressed heart failure swelling of cervical veins is observed. There is a violation of intracardial conductivity which even at the small centers of defeat can become the reason of arrhythmia and lead to a lethal outcome. Violation of a warm rhythm is shown by supraventrikulyarny (supraventricular) premature ventricular contraction, is more rare attacks of vibrating arrhythmia that considerably worsens haemo dynamics, strengthens symptoms of heart failure.

In most cases in a clinical picture of myocarditis prevail only separate of the listed above symptoms. Approximately at a third of patients myocarditis can proceed malosimptomno. At the myocardites arising against the background of collagenic diseases, and also a viral infection often there is accompanying perikardit. Idiopathic myocarditis has heavy, sometimes the malignant current leading to a kardiomegaliya, heavy violations of a rhythm and conductivity of heart and heart failure.

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Myocarditis complications

At it is long the current myocarditis sclerous damages of a cardiac muscle develop, there is a miokarditichesky cardiosclerosis. In case of sharp myocarditis at heavy violations of work of heart the heart failure, arrhythmia becoming the reason of sudden death quickly progresses.

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Diagnosis of myocarditis

Essential difficulties in diagnosis of myocardites are caused by lack of specific diagnostic criteria. Actions for identification of inflammatory process in a myocardium include:

  • Collecting anamnesis
  • Fizikalny inspection of the patient - symptoms vary from moderate tachycardia to dekompensirovanny ventricular insufficiency: hypostases, swelling of cervical veins, violation of a rhythm of heart, stagnant process in lungs.
  • The ECG - violation of a warm rhythm, excitability and conductivity. ECGs changes at myocarditis are not specific as are similar to changes at various diseases of heart.
  • - myocardium pathology (expansion of cavities of heart, decrease in sokratitelny ability, violation of diastolic function) in different degree depending on disease severity comes to light.
  • The general, biochemical, immunological blood tests are not so specific at myocarditis and show increase in contents α2 and γ - globulins, increase in a caption of antibodies to a cardiac muscle, positive RBML (reaction of braking of migration of lymphocytes), positive test on S-jet protein, increase in sialovy acids, activities of cardiospecific enzymes. The research of immunological indicators has to be conducted in dynamics.
  • The X-ray analysis of lungs helps to find increase in the sizes of heart (kardiomegaliya) and stagnant processes in lungs.
  • Bakposev of blood for identification of the activator, or PTsR diagnostics.
  • The Endomiokardialny biopsy by means of sounding of cavities of heart including a histologic research of bioptat of a myocardium confirms the diagnosis of myocarditis no more than in 37% of cases because focal damage of a myocardium can take place. Results of a repeated biopsy of a myocardium give the chance to estimate dynamics and the result of inflammatory process.
  • Stsintigrafiya (radio isotope research) of a myocardium is a physiologic research (natural migration of leukocytes in the center of an inflammation and suppuration is traced).
  • The magnetic and resonant tomography (heart MRT) with contrasting gives visualization of inflammatory process, hypostasis in a myocardium. Sensitivity of this method makes 70-75%.
  • The radio isotope research of heart, magnetic and resonant tomography allow to define zones of damage and a necrosis of a cardiac muscle.
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Treatment of myocarditis

The sharp stage of myocarditis demands hospitalization in office of cardiology, restriction of physical activity, a high bed rest for 4 - 8 weeks before achievement of compensation of blood circulation and restoration of the normal sizes of heart. The diet at myocarditis assumes the limited use of table salt and liquid, the enriched proteinaceous and vitaminized food for normalization of metabolic processes in a myocardium.

Therapy of myocarditis is carried out at the same time in four directions, performing etiologichesky, pathogenetic, metabolic symptomatic treatment. Etiologichesky treatment is directed to suppression of infectious process in an organism. Therapy of bacterial infections is carried out by antibiotics after allocation and definition of sensitivity of a pathogenic microorganism. At myocardites of virus genesis purpose of antiviral medicines is shown.

As necessary condition of successful treatment of myocardites serves identification and sanitation of the infectious centers supporting pathological process: tonsillitis, otitis, antritis, periodontitis, adneksit, prostatitis, etc. After implementation of sanitation of the centers (surgical or therapeutic), a course of antiviral or antibacterial therapy carrying out microbiological control of an izlechennost is necessary.

Include anti-inflammatory, antihistaminic and immunosupressivny medicines in pathogenetic therapy of myocardites. Purpose of nonsteroid resolvents is carried out individually, with selection of dosages and duration of a course of treatment; as criterion of cancellation serves disappearance of laboratory and clinical signs of an inflammation in a myocardium. At the heavy, progressing course of myocarditis glucocorticoid hormones are appointed. Antihistamines promote blocking of mediators of an inflammation.

At myocardites apply potassium medicines, inosine, vitamins, ATP, cocarboxylase to improvement of metabolism of a cardiac muscle. Symptomatic treatment of myocardites is directed to elimination of arrhythmias, arterial hypertension, symptoms of heart failure, prevention of tromboemboliya. Duration of treatment of myocarditis is defined by disease severity and efficiency of complex therapy and averages about half a year, and sometimes longer.

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The forecast at myocarditis

At latent malosimptomny the course of myocarditis perhaps spontaneous clinical treatment without the remote consequences. In more hard cases the forecast of myocardites is defined by prevalence of damage of a myocardium, features of inflammatory process and weight of a background disease.

At development of heart failure in 50% of patients improvement by results of treatment is noted, at a quarter stabilization of warm activity is observed, at the remained 25% the state progressiruyushche worsens. The forecast at the myocardites complicated by heart failure depends on expressiveness of dysfunction of the left ventricle.

The unsatisfactory forecast is noted at some forms of myocardites: gigantokletochny (100% mortality at conservative therapy), diphtheritic (mortality makes up to 50–60%), the myocarditis caused by Shagas's disease (the American tripanosomoz), etc. At these patients the issue of transplantation of heart is resolved, though the risk of development of repeated myocarditis and rejection of a transplant is not excluded.

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Prevention of myocarditis

For decrease in risk of incidence of myocarditis it is recommended to observe precautionary measures at contact with infectious patients, to sanify the infection centers in an organism, to avoid stings of pincers, to perform vaccination against measles, a rubella, flu, a mumps, poliomyelitis.

The patients who had myocarditis undergo dispensary observation at the cardiologist of 1 times in 3 months with gradual restoration of the mode and activity.

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Myocarditis - treatment should be carried out only under the supervision of a doctor. Self-treatment is unacceptable!!!

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