Myocarditis of the heart: causes, symptoms, diagnosis and treatment

The myocardium is the heart muscle located in its middle layer. She is responsible for pumping blood, uniformity of load distribution, rhythm of contractions.

Different kinds inflammation of the heart muscle are united by a common name - myocarditis.

Prevalence of myocarditis among other cardiac pathologies is 10 - 15%. These data are very approximate due to the fact that the disease often proceeds in an erased form and is not diagnosed. In 10% of cases the correct diagnosis is made by a pathologist.

Myocarditis of the heart can lead to the fact that part of the heart muscles is destroyed, such a patient needs hospitalization, in rare cases, an organ transplant may be required.

30 - 40-year-old people suffer from myocarditis more often, women get sick more often than men, but the form of their course is lighter.

According to statistics, every year the death rate from myocardial inflammation is 7% of all cases.

According to the type of development, inflammation of the myocardium is primary - an independent disease, and secondary, as one of the manifestations of general heart disease. Even if the disease is asymptomatic, it can cause heart weakness.

Diseases such as scleroderma can be accompanied by myocarditis., endocarditis, systemic lupus erythematosus.

Causes of myocarditis

Often the cause of myocarditis is not identified. There are many potential causes, but the likelihood of developing myocarditis is rare. Potential common causes (pathogenesis) include:

• viruses;
• bacteria;
• fungi (yeast infections).

The disease can also occur due to exposure to:

• chemicals or radiation;
• drugs used against cancer;
• antibiotics (especially penicillins);
• sulfonamide preparations.

The causes of acute myocarditis, which can develop into chronic, are:

• flu;
• chicken pox;
• rubella;
• measles;
• herpes;
• hepatitis a, b;
• ARI.

The time of epidemics of viral infectious diseases is the most dangerous for the occurrence of acute myocarditis. It can develop as a complication after a viral infection.

The most susceptible to acute myocarditis are young men and men of young age, pregnant women, young children, people with weakened immunity.

Classification of myocarditis

Inflammation can cover different areas of the myocardium.

• On the basis of its spread, the disease is divided into diffuse - covering the entire muscle, and focal. With focal myocarditis, inflammation develops in one area of ​​the myocardium, the rest of its tissues are not damaged. Diffuse myocarditis is more severe, its symptoms are more pronounced.
• By origin, the disease is divided into rheumatic, non-rheumatic and myocarditis, concomitant with another disease:
  • rheumatic appearance is one of the forms rheumatismcaused by streptococcus;
  • non-rheumatic myocardia occurs from infection with bacteria, viruses, fungi and parasites in the human body.

According to the mechanism of myocardial inflammation, the disease is divided into:

• Infectious. Occurs during or after flu, childhood viral or bacterial disease, parasites.
• Allergic myocarditis, or combined toxic-allergic, resulting from thyrotoxicosis, uremia, alcoholic or drug intoxication. Adults often suffer from this type of myocarditis due to the use of cocaine.
• Idiopathic - the nature of this type of myocarditis has not been clarified. This rare type of myocarditis is difficult and is accompanied by the following complications:
  • heavyheart failure;
  • thrombosis;
  • heart attack.

The disease of the idiopathic mechanism develops with lightning speed, blood pressure drops, shortness of breath appears, chest pains, swelling, arrhythmia, the size of the heart increases in all directions. This type of myocarditis occurs more often than others.

By the type of the course of the disease, it is divided into:

• lightning fast;
• sharp;
• medium (subacute);
• chronic.

The lightning-fast course of development can cause cardiogenic shock. This form ends either in self-healing or is fatal.

Myocarditis symptoms

The disease has no characteristic symptoms, and it is easy to confuse them with many other diseases.

Often, at the beginning, myocarditis is generally asymptomatic and is detected as a result of a comprehensive examination (diagnosis).

If myocardial inflammation occurs against the background of a viral or bacterial disease, then the patient, in addition to complaints of symptoms characteristic of acute respiratory infections, complains about chest pain, shortness of breath.

The pains are stabbing, pressing, spreading to the entire chest, appear suddenly. At the same time, the patient indicates increased fatigue, increased sweating.

The second symptom that causes suspicion of myocarditis is tachycardia. The patient dizzy, periodic fainting. The size of the heart with myocarditis increases, and blood pressure becomes below normal.

Consequence heart failure, which often occurs with myocarditis, may be dilated cardiomyopathy. Extrasystoles (heart rhythm interruptions) occur, the patient feels strong tremors of the heart. With physical exertion, shortness of breath occurs, appear swelling of the legs, the tips of the fingers, nose and earlobes turn blue.

Attention! The course of myocarditis is especially difficult in smokers. This bad habit can provoke myocardial infarction.

The presence of all the listed symptoms in one patient usually does not occur, the predominance of certain symptoms depends on the type of myocarditis.

Signs of acute and chronic myocarditis.

A person who has suffered a viral illness begins to experience a feeling of fear, irritability, and insomnia. After a while, chest pains appear, which are accompanied by:

• an increase in temperature;
• weakness;
• interruptions in the heart;
• lowering blood pressure;
• muscle pain;
• sweating.

The symptoms of chronic myocarditis are the same as in dilated cardiomyopathy:

• rapid fatigue;
• dyspnea;
• orthopnea;
• dry cough;
• asthma attacks.

If the disease becomes progressive and the patient does not receive the necessary treatment, the probability of death is 50%.

Advice! Do not tolerate colds on your feet, if at least one of the listed symptoms appears, immediately consult a doctor. Self-medication will only aggravate the condition and can lead to the transition of myocarditis into a chronic form.

Feature of myocarditis in children

The disease in children is divided into congenital and acquired.

In the first case, a newborn has an enlarged heart, at the age of six months, such manifestations as pallor of the skin, lethargy, shortness of breath when feeding, lack of weight are visible, tachycardia is observed.

Read also: tachycardia of the heart - what is it and how to treat.

Acquired myocardial inflammations are acute, subacute and chronic. Acute myocarditis in children occurs after ARVI. Its symptoms are:

• dyspnea;
• blue discoloration of the skin;
• sleep disturbance;
• vomit;
• fainting.

Subacute and chronic forms of myocarditis are almost asymptomatic and prolonged in time. If the diagnosis is not made in time and the course of treatment is not started, circulatory disorders may occur, the child may become disabled.

Feature of myocarditis in pregnant women

A woman who is expecting a child may develop myocarditis if she has had an infectious disease, sometimes this is a consequence of severe toxicosis or anemia.

Signs appear a month before childbirth or six months after the birth of the child. If a woman has had myocarditis before, pregnancy can provoke its exacerbation.

When planning pregnancy, women who have had such a diagnosis should undergo examination and take preventive measures.

When diagnosing a disease, you should not give up X-ray. This examination is not as dangerous for the fetus as many think, the consequences of myocarditis will bring much more harm than X-ray, besides, when examining the chest, the uterus and small pelvis are reliably covered from radiation.

Treatment of pregnant women takes place only in a hospital, bed rest and a salt-free diet are indicated. The condition of the mother and the fetus is monitored, and the council of doctors determines the course of therapy.

Diagnosis of myocarditis

Due to the lack of characteristic signs of myocarditis, late diagnosis is a frequent problem. At the same time, it is necessary to establish the primary disease that attracted myocarditis. For this, a comprehensive examination is prescribed, which includes:

• anamnesis (information about the medical history, living conditions of the patient, the diseases he suffered);
• examination of the patient (the doctor listens to the patient in order to identify noise in heart, tachycardia. Examination reveals the presence of edema, swelling of the cervical veins, cyanosis of the skin. The signs established after the examination do not give grounds for making a diagnosis, but speak only of the presence heart failure. The doctor clarifies the diagnosis based on the results of subsequent studies);
• general blood test - needed to detect inflammation and identify the disease;
• bacterial blood culture - identifies the causative agent of the disease;
• MRI of the heart determines the zones of destruction of the heart muscle;
• ECG - the state of the heart rhythm, excitability and patency. The ECG does not give an accurate diagnosis, since its changes are similar to signs of other diseases. The patient's ECG is taken twice - before the start of therapy and in the process, and the results are compared. If the therapy did not affect the indications, we can talk about the chronic course of myocarditis. Sometimes the doctor decides to conduct daily monitoring of the heart;
• echocardiography will help to see the work of the heart in real time, learn about the thickness of the heart muscle, myocardial contractility;
• radiography and Ultrasound of the heart show a change in its size, violations in the myocardium and the presence of pulmonary edema. The heart muscle thickens due to inflammation, so x-rays show that the heart is enlarging. The more severe the inflammatory process, the more the dimensions are changed. But even if the boundaries of the heart are within normal limits, the disease cannot be ruled out. Ultrasound is done to distinguish it from other heart diseases;
• biopsy - performed only with a poor prognosis of myocarditis in order to establish the presence of tissue necrosis in the heart.

Treatment myocarditis

Myocarditis therapy must be carried out in a hospital. In the first 4 to 8 weeks, the patient is shown strict bed rest, further limitation of physical activity is recommended.

For the early suppression of the infectious process, antibiotics or antiviral agents. Also, the patient receives drugs that lower fever, relieve pain (NSAIDs) and antihistamines.

A patient with acute myocarditis is sanitized for foci of chronic infection with subsequent control. If the rehabilitation has not yielded results, hormonal drugs are prescribed.

When treating myocarditis, the patient is prescribed a special diet that excludes the use of salt, limitation of the amount of liquid, refusal of fried and smoked foods. Adding fruits, vegetables and complete protein foods to the diet is encouraged.

When the inflammation of the myocardium is removed, the patient is discharged. In the future, he needs to be constantly monitored by a cardiologist, and in severe cases, he must go to the hospital twice a year for a preventive examination.

In the future, such patients are not recommended to overcool and overload themselves physically.

Therapy for infectious myocarditis is aimed at suppressing the infection that led to myocarditis, the doctor also recommends bed rest, reducing salt in the diet, quitting smoking and alcoholic beverages, reducing physical activity, correct food.

Of the drugs for the treatment of infectious myocarditis, antihistamines, anti-inflammatory drugs and agents that suppress autoimmune reactions are prescribed. Also, with an infectious type, agents containing potassium are shown.

For the treatment of myocarditis not associated with a viral infection, therapy is used aimed at bacterial or parasitic infectious agents.

If the disease has arisen due to autoimmune pathology, immunosuppressive agents are used. In this case, constant monitoring by a doctor is necessary, since there is a possibility of blood clots.

Myocarditis therapy in children

In the acute course of the disease in children, myocarditis is also treated strictly in the hospital. The emphasis is on the treatment of the underlying disease, which resulted in myocarditis.

A special diet and drink will help alleviate the condition during treatment. It is necessary to comply with bed rest, while special exercises should be carried out, including breathing exercises.

It is important to create conditions under which the child will not be physically overwhelmed.

The danger of myocarditis in children is due to the fact that the child cannot tell about the signs himself, therefore adults should not ignore changes in behavior, the general condition of the child and should contact to the doctor.

If untreated, the child develops cyanosis, a heart hump.

Prophylaxis

Prevention of myocarditis is reduced to reducing the risk of contracting infectious or colds, to giving up bad habits and to timely vaccination. In the presence of unfavorable heredity, it is necessary to be observed by a cardiologist and undergo examinations on time.

To prevent myocarditis in children, you need to avoid infectious and viral diseases during pregnancy, and if infectious processes occur, do not resort to self-medication, but seek qualified medical help.

Forecast

Depending on the features of myocarditis, both complete recovery and severe complications, including death, are expected.

In 50% of cases of myocarditis, it is completely cured, therefore it is recommended not to neglect the advice of doctors, to be attentive to your health.

In chronic or subacute (moderate) form of myocarditis, the virus is constantly present in the patient's myocardium, as a result of the inflammation caused by it, the heart degrades. Antibodies designed to kill the virus destroy proteins in the heart muscle. This provokes the production of new antibodies, a vicious circle is formed. With this type of myocarditis, the prognosis is the worst.

The prognosis for asymptomatic myocarditis is much more favorable. In such cases, the patient's ECG is similar to the ECG when myocardial infarction. Additional examination is required by coronary angiography - an X-ray of the cardiac arteries. If it reveals a mild form of myocarditis, the patient will recover.