Myocarditis – inflammation of the heart muscle – myocardium (from mys – muscle and cardia – heart). Causes. The most common cause of myocarditis is rheumatism, infections and viruses, allergens. With any infectious disease, there is a chance of developing myocarditis.
Types of rheumatism according to the etiological factor.
Viruses: enteroviruses , adenoviruses, cytomegalovirus , HIV, hepatitis viruses, influenza, rubella, measles, herpes, infectious mononucleosis (Epstein- Barr ) and others. – bacteria: streptococci, staphylococci, pneumococci, meningococci, gonococci, diphtheria , dysentery, brucellosis , fungi, etc. – Protozoa and helminths: toxoplasmosis, trichinosis, cysticercosis.
- Toxic-allergic: drug, post-vaccination, transplant, with diffuse connective tissue diseases, injuries, burns;
- Idiopathic (i.e., unexplained etiology).
Rheumatic myocarditis usually occurs in childhood, usually together with endocarditis, the so-called rheumatic heart disease. With myocarditis, structural changes occur in the heart muscle, which can be focal or diffuse . In mild cases (with typhoid fever, flu, etc. ), changes can completely disappear without leading to damage to the muscle fibers in the heart. In severe cases, a certain amount of muscle fibers can be destroyed and a scar forms in their place – cardiosclerosis develops.
Infectious-allergic myocarditis begins in contrast to rheumatic myocarditis , usually against the background of infection or shortly after it.
In mild cases, myocarditis may not be recognized, since this kind of myocarditis does not cause a disturbance in well-being and does not give pronounced symptoms.
With some infections, myocarditis often acquires a more severe course. Rheumatic myocarditis, as a rule, has a protracted chronic course of up to several months, with exacerbations due to rheumatism and often leads to cardiosclerosis. Symptoms of the disease can manifest as heart failure and other cardiac abnormalities. Patients complain of weakness, shortness of breath, a feeling of pressure in the heart, fatigue, excessive sweating, low-grade fever, cardialgia , palpitations, arrhythmias , arthralgia. Cardialgia is more often pricking , sometimes oppressive, lasting, almost constant. The pain does not increase with physical exertion and emotional stress, in contrast to angina pectoris and coronary heart disease. Aantianginal drugs do not relieve pain. Objectively : tachycardia, possible arrhythmias, a drop in blood pressure, vasodilation. Diagnostics.
- ECHO-ECG can establish focal and diffuse changes in the myocardium.
- Laboratory: leukocytosis or leukopenia, eosinophilia , increased ESR, etc.
Prevention comes down to fighting infections and rheumatism, eliminating the causes of allergies.
TREATMENT OF MYOCARDITIS.
Strict bed rest. A sparing diet with the exception of meat and foods that enhance fermentation processes.
- In case of infections and viruses , appropriate treatment is carried out, if necessary, Antibacterial and Antiviral treatment is prescribed , depending on the infectious agent.
- With signs of heart failure, restriction of fluid and salt intake. In congestive heart failure , treatment is carried out with generally accepted means: diuretics, ACE inhibitors, cardiac glycosides, β- blockers .
- With rheumatoid arthritis, NSAIDs, salicylates are prescribed , in severe cases, glucorticosteroids, sometimes immunosuppressants , are prescribed .
- When an arrhythmia of the heart prienyayut antiarrhythmic drugs.
- At the risk of thromboembolism is assigned to anticoagulant therapy (heparin, low molecular weight heparins)
- For the treatment of allergic reactions, it is necessary firstly to establish an agent using a detailed history, then eliminate the allergen, H1-blockers.
Duration of myocarditis treatment (1-6 months or more)