Myocarditis - damage to the heart muscle, which is caused by inflammation.As shown by numerous observations in children with myocarditis in the process is almost always involved simultaneously all three membranes of the heart.Signs indicating the involvement of other heart membranes, are negligible and smoothed the changes in the myocardium.This explains the widespread use of the term "myocarditis", but it does not reflect all of the pathological process and its prevalence.Due to the fact that, in fact, there is loss of cardiac membranes, use of the term "carditis".
in recent years attracted the attention of hereditary factors in the formation of carditis.The disease occurs in these cases, almost imperceptibly, with the development of heart failure only in the final.At the heart of congenital carditis , probably it is genetically determined defect of antiviral immunity.Viruses can be transmitted from parents to offspring ( "family" viruses), and then they call a hidden (latent), chronic infection, or s
diagnosis of congenital carditis is considered valid in the case of heart disease symptoms are detected in utero or in the hospital.Congenital carditis is likely if all the signs of this disease occur in the first months of life without prior disease and (or) in the case of the mother during pregnancy diseases.Depending on the violation of the anatomical structure of the body (heart), congenital carditis divided into early and late.Mandatory early carditis morphological feature is the excessive proliferation or dysplasia elastic (fibroelastosis) or connective tissue (elastofibroz) and endo-myocardial fibers.Late cardites this feature do not have.A large number of elastic tissue in the heart indicates its damage on the 4-7 rd month of fetal development (early fetal period) when the fetal tissues respond to the growth of any damage resulting from cell division that leads to the development of fibrosis and elastosis.With the defeat of the heart after the 7th month (late fetal period) formed a common inflammatory reaction, and fibroelastosis not develop.
In early congenital carditis reveal an increase in the size of the heart (cardiomegaly) with an extension of the left ventricular cavity and thickening of its muscular coat.The inner lining of the heart and significantly thickened.
first signs of congenital heart disease in both cases of early congenital carditis appear first 6 months of life (rarely 2-3-year).The child starts to lag behind in physical development of their peers, there are lethargy, pallor, tired quickly when feeding.An examination of the doctor detected an increase in the size of the heart (cardiomegaly), developing early heart hump (deformity of the chest).When listening to the work of the heart is determined voiceless heart tones, no noise.Somewhat later joined by signs of heart failure, resistant to treatment.
additional child survey methods include ECG, X-ray examination of the chest, heart catheterization and angiocardiography cavities.When X-ray of the chest determines the shape of the heart.For fibroelastosis more typical globular or ovoid shape of heart for postmiokarditicheskogo elastofibroza - trapezoid.When catheterization of heart cavities and angiokardiografii detected signs of myocardial contractility (muscle) of the left ventricle with a moderate increase in pulmonary artery pressure.
In late congenital carditis in the pathological process involved at the same time, two or all three of the heart membrane.Amazed and cardiac conduction system, which carries out the reduction of the heart muscle.The defeat of this system gives rise to a variety of cardiac arrhythmias.Sometimes it affects the blood vessels that feed the heart (coronary arteries), there is sclerosis of the heart muscle and thickening of the muscular layer (myocardium).A child with such a disease quickly tired when feeding, excessive sweating occurs.Starting with the 3-5 th month after the birth of the baby starts gaining weight is not enough.Some children are marked changes in the central nervous system: sudden attacks of anxiety with increased shortness of breath and bluish coloration of the skin, convulsions, sometimes with loss of consciousness.The signs of cardiac disease are: moderate expansion of the boundaries of the heart, heart sounds loud, less pronounced than in the "early" carditis, heart failure, abnormal noise while listening to no heart.Quite often there are abnormal heart rhythm with an increase or slowing of the heart rate.
Acute carditis laboratory blood tests can produce results that are typical of an inflammatory process of the myocardium.The blood tests determine the acceleration of ESR, increasing the number of white blood cells, increasing the level of proteins (a and y-globulins).These changes reflect the blood flowing in the body of the child viral infection.The most reliable confirmation of the disease is a virus isolation from blood, nasopharyngeal mucus, feces, as well as the definition of the high content of antibodies against the virus.
additional methods of examination of the child are an electrocardiogram, X-ray of the chest cavity.
carditis treatment consists of two stages: a stationary (acute phase or exacerbation) and polyclinic or sanatorium (during maintenance treatment).Necessary to carry out activities to address the causes of the disease (impact of drugs on the virus, the effects on the immune system, fight against cardiovascular insufficiency).Carry out a general plan for the event and medication.By the general plan measures include compliance with the motor, food, drinking regime.
Acute carditis is recommended to limit the motor activity of the child within 2-4 weeks.Feeding a child in this period must be complete with plenty of vitamins, proteins, restriction of salt, an increased amount of potassium salts (raisins, apricots, figs).Drinking regime is determined by the number of allocated urine per day: the child is given by 200-300 ml of liquid is less than the selected number of them.Antibiotic treatment is carried out within 2-3 weeks.The main goal of this treatment is the prevention of a variety of bacterial complications in infants.When extensive lesions of the heart with the development of heart failure, with subacute onset of the disease (which is a precursor to the transition to chronic carditis), hormones (prednisolone) is used in the carditis with a primary lesion of the cardiac conduction system.If, despite this treatment, the disease becomes chronic, it is prescribed medications such as delagil plakvinil or in combination with indomethacin or Voltaren.
At the same time we treat cardiovascular disease.To improve the contractile function of the heart, cardiac glycosides are used, for example digoxin.
great attraction place children with acute carditis and heart failure is given diuretic drugs.The particular drug must be chosen only by the attending physician, since this is necessary to know the stage of heart failure, and improper use of the drug (which in most cases happens when self-medication) can lead to adverse consequences.
also in the treatment of carditis widely used drugs that enhance metabolism in the myocardium: Pananginum, Riboxinum, orotate potassium, vitamin B12, folic acid, calcium pangamat, calcium pantothenate.
In chronic carditis should not be a long time to adhere to bed rest as detraining adversely affect the cardiovascular system.
Children with congenital carditis after discharge from the hospital, where they spend an average of 1.5 months, comes under the supervision of pediatricians and cardiorheumatology.Doctors monitor the implementation of the appointments and the recommendations made in the hospital, and spend their correction if necessary.Such drugs like digoxin and Pananginum, children receive long-term.There should be continuous monitoring of the cardiologist with a regular ECG monitoring (1 every 3-6 months), chest X-ray (1 every 6-12 months and more often if you suspect a worsening of the disease).
Preventive vaccinations are contraindicated for all children with acute carditis for at least 3-5 years.In chronic carditis vaccination is contraindicated.