Myocarditis - Causes, Symptoms and Treatment .MF .
Myocarditis - focal or widespread inflammation of the heart muscle as a result of various infections, effects of drugs, toxins or immune processes that lead to cell damage of heart tissue and the development of heart failure.The true incidence of myocarditis is difficult to estimate, since in most cases it occurs without symptoms bright and usually ends in complete recovery.According to the postmortem studies of deaths, the prevalence of the disease varies from 1 - 4%.As sick more often data statistics myocarditis people of reproductive age to 40 years.Women are susceptible to this disease to a greater extent than men, but the male half of the population is exposed to more severe forms of myocarditis, flowing with severe complications.
causes of myocarditis and its forms.All
reasons that in some form or other can give rise to inflammation in heart muscle can be divided into three main groups.It's infectious and infectious-toxic causes.These viruses include: measles, mononucleosis, adenovirus, influ
allergic group: as a result of exposure to drugs (sulfonamides, cephalosporins, anti-depressants), systemic connective tissue diseases.This activates the body's immune system in the wrong mechanism that trying to suppress inflammation, takes its organs and tissues of the pathogen and the object of their attacks.
toxic effects (drugs, alcohol, thyroid disease and diabetes) have a direct effect on the heart muscle, leading to cell death.
Symptoms arising from myocarditis.
Adrift distinguish several forms of myocarditis, depending on the onset of symptoms and the duration of their existence.Acute myocarditis is characterized by acute onset and severity of clinical manifestations.Subacute myocarditis is characterized by less bright clinical picture, moderate changes in laboratory assays.Chronic myocarditis is characterized by a prolonged course with periods of exacerbation and the complete disappearance of all symptoms.Also there are three degrees of severity of myocarditis: light, medium-heavy and severe.
symptoms of myocarditis do not have any specific features, which could be a 100% certainty that this is the pathology.But in most cases can be traced the relationship of heart disease to infection or other causes listed above.The disease most often develops after a few days (sometimes - weeks) after a viral infection, and in most cases are asymptomatic.In most cases (60%) patients begin to feel pain in the heart, which usually come from the area around the nipple and can spread to the entire chest area.Pain is usually crushing or stabbing character, long-lasting and do not depend on physical exertion or stress, t. E. May occur alone.
Shortness of breath - the second most common symptom of this myocarditis.Its appearance is associated with decreasing contractility of the left heart.There are usually in severe physical effort, with the mild form of myocarditis, or even at rest - with moderate and severe forms.Shortness of breath may be increased when the patient takes a horizontal position.
Heart palpitations say 47.3% of patients with myocarditis.Interruptions in the work of the heart, dizziness, and syncope occur as a consequence of arrhythmias and are the root causes of the patients who are treated.In the long myocarditis may appear swelling in the legs, which are a consequence of a lack of heart.
If you start to notice any of these symptoms in yourself and you have recently been ill with a viral infection, or abusing alcohol and drugs, contact your GP.
you'll need to tell your doctor: Did you have colds, there was an increase in body temperature, joint or muscle pain, skin rash.It is also necessary to inform concerned if you have pain in the heart or chest and what this pain is associated (physical activity, eating or having pain at rest).You have to ask, there you have fatigue lately, whether there are nocturnal attacks of breathlessness or palpitations.Then the doctor will need you to watch and listen.
From laboratory diagnostic methods in the general analysis of blood will be observed an increase in the number of leukocytes and ESR acceleration.However, these figures may not be permanent and depend on many factors.Some patients in the biochemical analysis of blood can increase the level of myocardial enzymes (CK, CK-MB, LDH), the rate of increase which reflects the severity of the inflammatory process in the tissue of the myocardium.
Some controversial situation to determine the cause of myocarditis and the presence of certain symptoms should be analyzed to detect antibodies to the virus cardiotropic, which has a four-fold increase diagnostic value.
Instrumental methods of diagnosis include: EKG and ECG monitoring by Holter.Myocarditis can cause abnormalities on the ECG.There may be a variety of arrhythmias, such as sinus tachycardia or bradycardia, and other species.When performing echocardiography in patients with asymptomatic or oligosymptomatic myocarditis, the changes may not be available or may detect minor quantitative changes in blood volume.In severe degree of myocarditis with heart failure decreases contractility of the heart and blood volume, which it emits.
X-rays to determine the severity of the heart to increase in volume and signs of stagnation of blood in the lungs.In very rare cases and for special indications performed a biopsy of the myocardium.A definitive diagnosis can be established only after this invasive method.
When the diagnosis of "myocarditis" is necessary to eliminate the disease, occurring with secondary lesions of the heart, that is, those diseases which, due to its complications lead to the development of inflammation in the heart.
to exclude endocrine, metabolic and general systemic diseases as the main cause of the defeat of the heart muscle for the differential diagnosis of non-rheumatic myocarditis.Very often pain in the heart take over stenokardicheskie, I would like to list the main differences.Patients with myocarditis usually indicate recent infection, patients have predisposing factors to the development of coronary heart disease (smoking, high blood pressure, metabolic disorders), for angina is characterized by the positive effect of nitroglycerin.For myocarditis, which develops in young children, should take into account the possibility of congenital disorders (eg, neuromuscular diseases, endocrine pathology, congenital anomalies of the vessels).
For a more detailed analysis of the causes of endocarditis is necessary to consult a rheumatologist, ENT, infectious diseases, cardiac surgeon.
Treatment of myocarditis.
During treatment it is necessary to solve a few highlights: it is necessary to prevent the irreversible enlargement of the heart chambers, to reduce to a minimum the risk of chronic heart failure.For suspected myocarditis, all patients should be hospitalized.It is necessary to comply with bed rest, the duration of which depends on the degree of myocarditis.In severe the risk of complications of treatment should be done in an intensive care unit.Diet must be observed during treatment and after a long period of time with fluid restriction and salts.
Drug treatment in patients myocarditis should be directed at eliminating the causative factors and treatment of symptoms of myocarditis directly.It is also necessary to adjust the immune system and eliminate possible further complications.Since in most cases the cause of myocarditis is a viral infection that is necessary to antiviral therapy (polyclonal immunoglobulins, interferon alpha, riboverin) in the acute phase of the disease on symptoms of altitude.
With the development of myocarditis on the background of a bacterial infection the patient shows the use of antibacterial agents.An antibiotic is prescribed based on the underlying disease.From the most commonly used antibiotics erythromycin, doxycycline, monotsiklin, penicillin, oksatsilin.It is necessary to carry out sanitation of chronic infection foci, which will favorably affect the outcome of myocarditis.
In severe forms of myocarditis with high activity as prevention of thromboembolic complications administered heparin.Antiarrhythmic agents are used in patients with tachycardia and other cardiac arrhythmias.
Surgical treatment is indicated in patients with persistent arrhythmias that do not respond to conventional therapy.They implanted an external pacemaker that is generating the correct frequency rate, it causes the heart to contract and ensure the normal circulation.
After recovery rate doctor visits depends on the form of myocarditis.In focal myocarditis or light is shown watching a cardiologist 1 every 6 to 12 months.At moderate - every 3 months, and in severe need rehospitalization.Keep in mind that if you have ever been ill myocarditis you need to avoid hypothermia, intense exercise, reduce salt intake to 3 grams per day, with the appearance of shortness of breath and swelling in the legs, immediately consult a doctor.
Prevention and prognosis.
Myocarditis may develop as a manifestation or complication of any infectious diseases (especially viral), so myocarditis prevention reduces mainly to the prevention of these diseases.It consists in carrying out of preventive inoculations and vaccinations against infectious agents are those that directly affect the heart (measles, rubella, influenza, polio, diphtheria).All patients who have a family history of sudden death or heart failure at a young age, you must pass a medical examination and ECG - study at least once a year.In addition to the survey, to avoid work-related congestion or professional sports.
With regard to prognosis of myocarditis, the rule of "three": one-third of patients recover, one-third - developed heart failure, and even a third of the state deteriorates rapidly and can be fatal.Therefore, watch your health, and not get sick!
therapists Zhumagazy EN