Myocarditis diagnosis. Treatment of acute myocarditis in children. General symptoms of myocarditis

Myocarditis is the general name for inflammatory processes in the heart muscle or myocardium. The disease can appear against the background of various infections and autoimmune lesions exposure to toxins or allergens. There are primary inflammation of the myocardium, which develops as an independent disease, and secondary, when cardiac pathology is one of the main manifestations of a systemic disease. With early diagnosis and complex treatment myocarditis and its causes, the prognosis for recovery is the most successful.

Description of the disease

For the first time, they started talking about myocarditis in the first half of the 19th century, when scientists proposed the very concept of the disease, and later - the forms of manifestation, acute and chronic. Already at that time, the main cause of pathology was considered various infections, but came close to the study of this disease only after the Second World War. In those years, most sufferers severe infections ( , relapsing fever and others), as well as, myocarditis developed, however, during lifetime, manifestations of the disease were recorded only in a quarter of patients.

Nowadays, myocarditis is not among such dangerous cardiovascular pathologies, as or : in most cases, patients with myocardial inflammation recover quite successfully. The increase in the number of lesions of the heart muscle is usually due to seasonal outbreaks and, also quite often, such a complication develops with rheumatism - in 30% of cases.

The disease occurs when the heart muscle is exposed to enemy agents (viruses, bacteria, toxins, etc.). Damaged areas are replaced by connective tissue, which disrupts the main cardiac functions, and subsequently, cardiosclerosis develops. The timing of treatment and prognosis entirely depend on the area and degree of myocardial damage. Like other heart diseases, myocardial inflammation is rapidly getting younger: today, young people under 40 are at risk, and children are often diagnosed with this disease.

The reasons

The main reason for the development of myocarditis in patients is infectious diseases, but most often the disease is detected against the background of viral pathologies - about 50% of all cases. Often, two or more infections become the cause of inflammation, in which case one of the diseases creates the conditions for the disease, the second directly affects the heart muscle.

Most often, patients develop secondary myocarditis as a complication of severe infection, connective tissue damage, burn disease, transplant rejection after surgery, etc. In some cases, primary, or isolated, myocardial damage is diagnosed that is not associated with a specific disease. Usually it is allergic or viral myocarditis, while the virus multiplies directly in the heart cells, and the classic manifestations of infection (runny nose, cough, lacrimation, temperature fluctuations) are absent.

There are also additional factors that can serve as a kind of trigger for the development of myocarditis: chronic infection (cholecystitis, pulpitis, adnexitis), hypothermia, malnutrition, constant stress.

Varieties of the disease

Currently, there are several classifications of myocarditis for various reasons, but traditionally such pathologies are divided according to the severity of the course, the nature and cause of occurrence.

According to the severity of the flow, they distinguish:

• Easy form;
• Medium form;
• Heavy form.

At the initial stage of myocarditis, there are no noticeable functional and morphological cardiac disorders. With an average form of the disease, the heart is already increasing in size, but there are no noticeable violations of cardiac activity yet. With the transition of the inflammatory process into a severe form, the heart increases even more, develops, rhythm disturbances, etc.

According to the nature of the course, myocarditis is divided into the following varieties:

• Spicy;
• Subacute;
• Chronic.

Acute myocarditis begins rapidly and is characterized by vivid symptoms(shortness of breath, chest pain, arrhythmia, Blue colour skin, etc.). The subacute form is less severe and provokes minor changes in cardiac activity. Chronic myocarditis can develop in two forms - it is either a progressive disease with increasing symptoms of a heart disorder, or a classic chronic illness with periods of remission and exacerbation.

obvious symptoms and acute development diseases - feature infectious and toxic myocarditis. Allergic, infectious-toxic and infectious-allergic myocarditis usually occur in a chronic form.

Due to the disease, there are:

• Rheumatic;
• Infectious (divided into infectious-toxic and infectious-allergic);
• At systemic diseases connective tissues, burns, injuries, radiation;
• Allergic;
• Idiopathic, or Abramov-Fiedler (unexplained nature).

Rheumatic myocardial damage develops after purulent tonsillitis against the background of already existing rheumatism. Infectious inflammation occurs with reduced immunity, when a pathogen enters the body. Viral myocarditis can also appear with an exacerbation of herpes, against the background of hepatitis B and C. allergic inflammation develops as a reaction to any allergen, from viruses and fungi to toxins and medications.

The most severe form of the disease is idiopathic. In this case, the disease usually develops rapidly and very severely, with tissue breakdown, heart failure and diffuse cardiosclerosis. In the most difficult situations the only way to save a patient with myocarditis is a heart transplant.

Symptoms

Myocarditis does not have any specific features allowing to make a diagnosis immediately and with a high probability. Often, inflammation of the heart muscle is almost asymptomatic and is detected only after an ECG. But if there is a secondary myocarditis of the heart, then it is possible to trace the relationship between the primary disease and myocardial damage.

The interval between the first signs of influenza or SARS and the development of cardiac inflammation is from several days to two weeks. The patient complains of classic manifestations of a viral or bacterial infection- weakness, elevated temperature, runny nose, sore throat, etc. Soon cardiological symptoms are added to them.

The first signs of myocarditis are chest pain and shortness of breath. About 60% of patients feel pain in the heart - discomfort focus on the nipple or spill over the entire breast. The pain can be different - stabbing, pressing, almost imperceptible or sharp. Discomfort usually occurs out of the blue and does not depend on any physical effort. Shortness of breath with myocarditis appears after exercise and often increases in the supine position.

Other classic manifestations of heart inflammation are tachycardia, irregular heartbeat, dizziness, and fainting. On the advanced stages myocarditis symptoms are as follows: the legs begin to swell, the skin becomes cyanotic, the patient feels constant weakness. If with subacute or chronic disease may not all symptoms appear, then acute myocarditis is usually characterized by a combination of all of the above signs.

Symptoms in different forms of myocarditis

Inflammation of the myocardium can manifest itself in different ways: the number of symptoms and the severity of their manifestation depend on the type of myocarditis, the size inflammatory focus, strength of immunity and aggressiveness of microorganisms that caused the infection. In the acute stage or during exacerbation of chronic myocarditis, the manifestations of the disease become stronger, with remission, myocarditis occurs with minimal external symptoms.

Infectious, allergic and infectious-allergic myocarditis can be recognized by the following signs:

• General weakness and drowsiness;
• Irritability, fatigue and decreased performance;
• Slight increase in body temperature;
• Pain in the chest area that is not treated with traditional drugs (nitroglycerin);
• Cardiac arrhythmias ( atrial fibrillation, tachycardia, bradycardia, etc.);
• Change in skin color to pale bluish and swelling of the veins in the neck;
• Shortness of breath and cardiac edema in the legs;
• Jumps in blood pressure.

With an infectious-toxic lesion, the symptoms of the disease appear immediately during a period of severe intoxication of the body. The infectious-allergic variety proceeds differently: signs of cardiac inflammation make themselves felt only 2-3 weeks after the onset of the infection.

Rheumatic myocardial damage passes more calmly, without pronounced symptoms. Patients complain about weak pains in the chest without a clear localization, slight shortness of breath with strong physical exertion, occasionally - to interruptions in the heart rhythm.

The idiopathic variety of myocarditis is uncommon, but is characterized by severe course With various complications up to thrombosis and heart attacks. With this form of the disease, severe heart failure rapidly develops: shortness of breath, pain in the heart and liver, swelling in the legs, cardiac asthma, pulmonary edema. Arterial pressure falls, upon examination, a uniform expansion of the heart in all directions is immediately visible, arrhythmia is observed. Later, thromboembolism occurs - blockage by blood clots of the arteries of the heart, lungs, spleen, kidneys.

Symptoms in children

Myocarditis in children is usually divided into 2 large groups: congenital myocardial damage and acquired.

At congenital pathology the child is born with an enlarged heart, and the first symptoms of the disease appear already from 6 months. The skin of the baby is very pale, the baby himself is lethargic, gets tired quickly when feeding, does not gain weight. On closer examination, it is easy to notice tachycardia.

Acquired childhood myocarditis has several varieties and can occur in three forms: acute myocarditis, subacute and chronic. Children under 3 years of age are more likely to suffer from viral, bacterial and fungal lesions of the myocardium, at an older age, an infectious-allergic form is usually diagnosed.

Myocarditis in children in acute form in the majority is a consequence of SARS. The first signs of heart inflammation - bad dream, night moans of the child, shortness of breath, blue skin, nausea along with vomiting, periodic fainting, cold extremities. At advanced stages of the disease, cyanosis begins (the skin acquires a stable bluish tint), a heart hump forms (increase chest in the form of a hump), rapid breathing.

Subacute and chronic myocarditis in children is less noticeable and may develop over time. If left untreated, the disease can lead to circulatory disorders, a decrease in the pumping function of the heart, and even early disability.

Diagnostics

The main problem in the treatment of various types of myocarditis is timely diagnosis. Inflammation of the heart muscle does not have specific signs, therefore, at the slightest suspicion of myocarditis, diagnosis should be carried out in a complex manner: conversation and examination of the patient, X-ray, ECG, laboratory research and others. Also, since myocarditis can be caused by the most different reasons, it is necessary to determine the primary disease and prescribe the appropriate treatment.

Main diagnostic methods to determine myocarditis is:

• History taking and external examination of the patient (all primary diseases, age, external symptoms myocarditis, heart murmurs, etc.);
• General and biochemical blood test (signs of inflammation are determined);
• X-ray and ultrasound (helps to find out if the heart is enlarged, the size of the valves, hypertrophy of myocardial tissues, etc. When examining children, ultrasound can differentiate infectious myocarditis from congenital heart defects);
• Blood culture to determine the causative agent of infection;
• ECG (registers various changes in the work of the heart).

Treatment

Treatment of myocarditis in the acute stage requires mandatory hospitalization. Within 2-3 weeks (if necessary, and longer), the patient needs complete psychological rest and good sleep.

Drug treatment for myocardial damage depends on the primary disease and may include the following groups of drugs:

• Antiviral agents;
• antibiotics;
• non-steroidal anti-inflammatory drugs;
• Antihistamines;
• Hormones;
• Various preparations for activation metabolic processes.

An important component of the treatment of myocarditis is a special salt-free diet. With such a diet, it is necessary to exclude fried, smoked and spicy dishes, salt to a minimum. You need to eat fractionally (5-6 times a day), the emphasis is on fruits and vegetables, whole grains, protein foods.

Treatment of myocarditis in children should also take place in a hospital. In chronic cardiac inflammation, it is important to provide complex therapy for 1.5–2 months and spa treatment to avoid relapses. After recovery, medical examination is necessary - a regular examination of the child every six months for 5 years.

Prevention and prognosis

Inflammation of the myocardium in most cases is a complication after any infection or allergic reaction. Therefore, the main method of prevention is prevention and timely treatment all viral, bacterial and fungal infections in adults and children.

To do this, it is necessary to carry out all available vaccinations to prevent the most common infectious diseases - influenza. It is also important to treat all chronic infections in time - caries,

Myocarditis can occur with any infectious disease, but at present, myocarditis is most commonly seen with viral infections. To non-infectious factors that cause myocarditis include some drugs (antibiotics, sulfonamides, etc.), sera and vaccines. Myocarditis also occurs in systemic diseases connective tissue, for example, in systemic lupus erythematosus and other systemic vasculitis.

Causes of myocardial inflammation special place take away rheumatism, in which myocarditis is one of the main manifestations of the disease, along with a combination with and pericarditis.

Depending on the cause of myocarditis, there are:

Rheumatic;

Infectious (viral, bacterial, rickettsial, etc., including with measles, rubella, chicken pox, diphtheria, scarlet fever, severe pneumonia, sepsis; the most common is the Coxsackie B virus, which is the causative agent of myocarditis in half of the diseases);

Allergic (drug, serum, post-vaccination);

With diffuse (systemic) connective tissue diseases, injuries, exposure to ionizing radiation;

Idiopathic (that is, of an unexplained nature) Abramov-Fiedler's myocarditis.

The leading role in the development of the inflammatory process belongs to allergies and impaired immunity.

How does myocarditis manifest itself?

Myocarditis can be either isolated (primary) or a manifestation of another disease (secondary).

Along the course, acute, subacute and chronic myocarditis and recurrent (with the presence of remissions - improvements for several months or years) are distinguished. The inflammatory process in the myocardium leads to a violation of its main functions.

Common to all types of myocarditis

Often myocarditis occurs without severe symptoms and is sometimes recognized only after the detection of changes in the ECG. In clinically expressed cases, patients complain of a variety of character, prolonged pain in the heart region not associated with physical activity, weakness, fatigue, shortness of breath and palpitations during exercise, interruptions in the work of the heart. Body temperature may be normal, but more often there is a slight increase to 37-37.90C.

Infectious myocarditis

Myocarditis begins on the background of an infection or shortly after it with malaise, sometimes persistent pain in the heart, palpitations and interruptions in its work and shortness of breath, and occasionally soreness in the joints. Body temperature is normal or slightly elevated. The onset of the disease may be subtle or latent. The severity of symptoms is largely determined by the prevalence and severity of the progression of the process. The size of the heart increases early. important but not permanent signs are rhythm disturbances (tachycardia, its increase, bradycardia, its slowdown, atrial fibrillation, extrasystole) and conduction (various blockades): palpitations, interruptions in the work of the heart, a feeling of "fading", "stopping". Myocarditis can be complicated by the development of heart failure. Infectious myocarditis can occur in two forms: infectious-toxic, in which signs of heart damage appear during a period of severe intoxication; infectious-allergic, in which signs of heart damage usually occur 23 weeks after the onset of an acute or exacerbation of a chronic infectious disease.

Idiopathic myocarditis

Idiopathic myocarditis is more severe, sometimes malignant course with the development of cardiomegaly, an increase in the size of the heart, severe rhythm and conduction disturbances, heart failure; often complicated by the development of heart failure, the appearance of blood clots in the cavities of the heart, which, in turn, separated by blood flow, cause necrosis (heart attacks) of other organs (thromboembolism).

Myocarditis in children

Myocarditis in a child, as well as in an adult, occurs as a result of the action of viruses and bacteria. For childhood, the presence of two types of myocarditis is characteristic:

congenital - in this case from the day of his birth, the child suffers from lethargy, pallor, shortness of breath. She gets tired quickly when feeding, does not gain weight. This type of disease is characterized significant expansion borders of the heart, tachycardia.

Acquired. This type myocarditis is divided into acute, subacute and chronic. Acute myocarditis is a consequence of SARS. Initial signs: lack of normal appetite, restlessness and moaning of the child at night, bouts of cyanosis (blue) and shortness of breath, nausea and vomiting. In the case of subacute and chronic myocarditis, both significant and minor symptoms. Minor ones include hepatomegaly (enlargement of the liver), a tendency to faint, and vomiting. Significant - cyanosis, heart hump (change in the shape of the chest above the heart in the form of a hump), tachypnea (increased breathing).

Allergic myocarditis

Allergic myocarditis occurs 12 to 48 hours after administration of a serum or drug to which the patient is allergic. Myocarditis in rheumatism and systemic diseases of the connective tissue Manifestations do not differ from those in any other forms of myocarditis. Myocarditis in this case is one of the symptoms of the underlying disease, which is established as a result of the examination.

Forecast

The prognosis depends on the form of the disease and its severity. With AbramovFidler's myocarditis, septic and diphtheria myocarditis, the prognosis for life is unfavorable. In most cases, myocarditis is asymptomatic and ends in complete recovery. Other forms of myocarditis with acute and subacute course not less than in 1/3 of cases come to the end with full recovery. In the remaining patients, an outcome in cardiosclerosis is observed, the state of heart functions depends on the localization and prevalence of which, or dilated cardiomyopathy develops. Extremely severe variants of the course of myocarditis with rapid progression of refractory heart failure and death are known. Cardiac arrhythmias can lead to sudden death.

Prevention

Prevention is the prevention and timely effective treatment infectious diseases. Sanitation of foci is necessary chronic infection treatment chronic tonsillitis, periodontitis, caries. In the prevention of serum and drug myocarditis, a strict justification of the indications for the use of serums and drugs, taking into account contraindications, especially in the presence of a history of allergies, is of decisive importance.

What can you do?

If the patient has young age or in a child who has not previously had heart problems, against the background of an infection or after it, there is pain and discomfort in the heart, interruptions in the work of the heart, you should immediately contact a cardiologist to receive the necessary treatment.

Elderly people suffering from any heart disease who suddenly have interruptions in the work of the heart, pain in the region of the heart that does not decrease with the usual intake effective drugs You also need to see a cardiologist.

What can a doctor do?

There are no strictly specific signs of myocarditis. Diagnosis is based on clinical signs, changes in the electrocardiogram, echocardiography, the presence laboratory signs inflammation, changes on radiographs.

Hospitalization is usually indicated for myocarditis. Measures general include bed rest, exercise restriction, oxygen inhalation as needed, and drug therapy.

Drug therapy depends on the underlying disease and the nature of cardiac disorders. In infectious non-viral myocarditis, antibiotics are prescribed, the choice of which depends on the isolated pathogen and its sensitivity to antibiotics.

Other areas include the treatment of heart failure, cardiac arrhythmias and conduction disorders, thromboembolic complications. In the first months after discharge from the hospital, patients who have had myocarditis should be monitored; physical activity should be limited.

The list of especially dangerous "silent killers", as diseases of the cardiovascular system are also called, also includes myocarditis (4-11% of all pathologies in this area). According to statistics, acute myocarditis in 17-21% of cases causes sudden death of young people.

What it is?

Myocarditis is an inflammation of the myocardium, the muscular layer of the heart. This disease can be "part of" various diseases or act as an independent disease.

Both acute and chronic myocarditis can cause heart failure, circulatory disorders, contractility and conduction of the heart, the consequences of which are often disability and fatal outcome.

It can be argued that this is a disease of people 30-40 years old, it is often diagnosed in children 4-5 years old and adolescents. At the same time, in young patients, myocarditis can be both acquired and congenital.

The reasons

Depending on the causes, clinical manifestations and consequences are distinguished: Chagas disease, toxoplasmic and giant cell myocarditis, Lim's disease, bacterial and radiation myocarditis, infectious, allergic and idiopathic (Abramov-Fiedler).

Allergies, ionizing radiation, alcohol poisoning, chemical substances, medicines, serums and vaccines can cause inflammation of the myocardium. In some cases, the cause of the disease cannot be established (idiopathic myocarditis).

Signs of the disease

If myocarditis is congenital, its symptoms often appear from the first days of a child's life: pale skin, shortness of breath, swelling, weakness. Children quickly get tired when breastfeeding, slowly gain weight. A medical examination may reveal expansion of the borders of the heart, tachycardia, muffled heart sounds, liver enlargement.

In older children, usually in the case of acquired infectious myocarditis, symptoms such as vomiting, nausea, cyanosis, sleep and appetite disturbances, and fainting also appear.

"Adult" symptoms of myocardial inflammation do not differ radically from those observed in children and adolescents. Complaints with myocarditis are nonspecific: fast fatiguability, shortness of breath, weakness, swelling, pain in the heart, arrhythmia and tachycardia. Often there is asthenic syndrome, characterized by mood swings, sleep disorders, tearfulness.

At the beginning, the signs of the disease are mild or may not appear at all, which makes it difficult to accurately diagnose. With the development of myocarditis, their list increases and the main ones are constant, pressing or stabbing pains in the region of the heart. A distinctive feature of such pain in myocarditis is that they are not stopped by taking nitroglycerin.

Joint pain, sweating, pallor of the skin, development of heart failure and enlargement of the heart also indicate inflammation of the myocardium.

Often the first symptoms appear within 7-10 days after the onset of the disease. However, depending on the type of myocarditis, this period may vary. So, with serum and drug myocarditis, symptoms appear already 12-48 hours after poisoning.

Myocardial cardiosclerosis, progressive heart failure and arrhythmia can be complications of myocarditis and cause sudden death.

For an accurate diagnosis in case of suspected myocarditis, a comprehensive medical examination is necessary: ​​ECG, echocardiography, blood tests, chest X-ray, MRI and radioisotope examination of the heart.

Treatment of myocardial inflammation

Mild forms of the course of the disease allow treatment in outpatient settings. However, as a rule, patients with a diagnosis of myocarditis are subject to hospitalization.

Treatment involves strict bed rest for up to 1-2 months, diet with restriction of the patient's intake of salt, liquid, meat, reduction of physical activity and medical methods therapy.

The latter vary depending on the type of myocarditis. In infectious inflammation prescribed antibiotic therapy, in case of allergic myocarditis - anti-inflammatory nonsteroidal drugs.

Also, patients with myocarditis are treated for heart failure, arrhythmias, infectious diseases, and they try to improve myocardial metabolism.

On how severe the disease was and how effective they were therapeutic measures, depends on the duration of treatment (usually - about six months). After completion of treatment, the patient should be under the supervision of a doctor for another 2-3 years.

Prognosis for myocarditis

Unfortunately, the prognosis for newborns is poor. But with timely and intensive medical care, there is a chance for recovery.

Preschoolers and older children tolerate myocardial inflammation more easily. This disease in childhood rated as good quality.

For adults, the prognosis is favorable, provided that the disease is detected in time and the treatment is properly selected.

In mild and asymptomatic forms of the course of the disease, spontaneous recovery can be observed.

At severe forms the course of the disease, the prognosis is given based on the state of the myocardium, inflammatory processes and exacerbations, as well as the severity of left ventricular dysfunction.

Myocarditis has a poor prognosis with giant cell myocarditis (mortality with conservative treatment- 100%), diphtheria inflammation of the myocardium (fatal outcome in 50-60% of cases) and myocarditis, which developed as a result of Chagas disease. Heart transplantation can save the lives of such patients.

Medicines used to treat

Patients suffering from myocardial inflammation are prescribed complex drug therapy, the goals of which are:

• removal of inflammation and relief of pain (anti-inflammatory non-steroidal drugs "Aspirin", "Indomethacin", "Ibuprofen" are used);
• blocking of inflammatory processes ("Suprastin", "Claritin");
• improvement of metabolic processes and acceleration of myocardial regeneration (potassium preparations are prescribed, such as Panangin, Asparkam, vitamins, anabolics such as Riboxin, Retabolil);
• prevention of thromboembolic complications (anticoagulants "Kleksan", "Fraksiparin" and antiaggregants "Plavix", "Egithromb").

Glucocorticoid hormones such as "Prednisolone" may be prescribed when the disease is severe and hormonal therapy is required.

It should be remembered that myocarditis cannot be treated on its own - this can lead to an acceleration of the development of the disease, the occurrence of complications and death.

Treatment with folk remedies

Traditional medicine offers many recipes designed to help treat myocarditis. However, these methods can only be used aid and after consultation with a doctor!

Among the many recipes, the following can be distinguished:

Lily of the valley tincture

A bottle filled with lily of the valley flowers is filled with 90% alcohol. The tincture is kept in a dark, cool place for a week, then filtered and drunk 20 drops three times a day.

Melissa and rosemary tincture

60 gr dried leaves chop rosemary, mix with lemon balm leaves, pour a liter of dry white wine. Leave the mixture out of reach of sunlight, in a cool place for 3 weeks, shaking occasionally. Take 50 ml before lunch or dinner.

Rosehip infusion

A handful of flowers pour 2.5 tbsp. boiling water, insist hour. Use one tablespoon of this tincture half an hour before meals.

Contribute to strengthening the heart and nuts, cheese, raisins, honey, cottage cheese, milk.

Disease prevention

Myocarditis prevention measures are three simple steps:

• Identification and elimination of foci of infections in the body - diseases such as tonsillitis, sinusitis, caries, etc.
• Caution during contacts with infectious patients, as well as when traveling to places where there is a high probability of tick bites.
• Timely vaccination against infectious diseases (influenza, measles, polio, mumps, rubella).

Summing up

1. Myocarditis is a serious disease caused by viruses, bacteria, and also arising from past illnesses or intoxication. Its symptoms often do not have a pronounced character.
2. If the appeal for medical help was timely, and the methods of treatment were chosen correctly, the disease has a favorable prognosis and can be cured without consequences for the body.
3. When the diagnosis of "myocarditis" is made, as a rule, the patient is shown hospitalization in cardiology department where is held mandatory treatment heart failure.
4. therapy - how medicines, and folk remedies- Only allowed under medical supervision.
5. Compliance with personal hygiene standards, vaccination schedule and timely detection and treatment of viral and infectious diseases are the main conditions for the prevention of myocarditis.

Cardiologist, Doctor of functional diagnostics

Dr. Zhuravlev has been helping patients with cardiopathology for many years to get rid of problems in the work of the heart and blood vessels, so the specialist conducts a comprehensive therapy for hypertension, ischemia, and arrhythmias.

Myocarditis was isolated as an independent unit as early as 1800. long time he was considered the most common illness hearts. Only since the beginning of the 20th century, when they realized that under the mask of myocarditis, previously unknown coronary artery disease and hypertonic disease, the diagnosis of myocarditis has become rare.

Therapeutic regimen

Treatment of myocarditis is not an easy task, it is complicated by the fact that specific treatment this disease does not exist. In this article, we will consider the basic principles of the treatment of myocarditis.

The most important treatment for myocardial inflammation is bed rest. Cardiologists consider it the main and main in the treatment of myocarditis.

Bed rest - the basis of the treatment of myocarditis

After all, the observance of rest has a beneficial effect on the state of the cardiovascular system. Everyone knows that any exercise stress during viral diseases leads to further spread of the virus through blood vessels, which can increase inflammation in the heart and lead to necrosis in the myocardium, not associated with coronary pathology.

The duration of bed rest is determined by the doctor, guided by the severity of myocarditis.

At mild degree severity, there are no signs of circulatory failure, the borders of the heart are not enlarged, laboratory indicators slightly increased, ECHO-KG shows signs of focal myocardial damage. With this severity, bed rest must be observed for 3-4 weeks until the period when the electrocardiogram returns to normal.

At moderate the course of myocarditis, in which there is already an expansion of the boundaries of the heart, clinical and laboratory parameters are very pronounced, the regimen is observed for at least 4 weeks.

With myocarditis severe degree diffuse myocardial damage occurs and heart failure joins. In this case, the regimen is observed until the symptoms of circulatory failure disappear.

Patients with severe myocarditis should be treated only in a hospital under medical supervision.

Treatment aimed at eliminating the infectious agent

As a rule, in most cases, myocarditis is caused by viruses. Patients are prescribed interferon drugs.

Very effective for any viral diseases candles viferon and genferon.

They include ready-made interferon (a protein that fights viruses and prevents their further reproduction), obtained by genetic engineering, so these drugs have powerful immunomodulatory properties, which favorably affects the course of myocarditis.

Treatment with drugs of this group is prescribed if viral infection still in full swing and myocarditis has already begun its development. If two or three weeks have passed since the onset of SARS, or enterovirus infection, then interferons are not used.

Patients with bacterial myocarditis are prescribed antibiotics, which are administered intramuscularly. The course of such myocarditis is favorable with careful sanitation of foci of infection (usually the nasopharynx and upper respiratory tract).

With non-infectious myocarditis, it is enough to cancel the provoking factor ( medications, exposure of patients, allergic factor).

Health food

With myocarditis, a strict diet is indicated. Usually assigned table number 10 and 10 a. main goal this diet is to facilitate the functioning of the cardiovascular system, increase diuresis (in the presence of signs of heart failure), spare organs digestive system and kidneys.

Characteristics of the diet

Limiting the intake of salt and water, foods containing cholesterol and causing. Also limit products that excite the heart and nervous system. The diet should not contain foods that irritate the liver and kidneys, but should be enriched with vitamins, magnesium and potassium.

The amount of free fluid, including soups, jelly, compote, in patients with myocarditis should be only 1.2 - 1.4 liters per day. All dishes are prepared without salt, meat or fish are boiled or stewed. At least 2300-2600 kcal should be the energy value diet of a patient with a myocardium.

The following are excluded from the patient's diet:

• alcohol, strong teas and coffee, cocoa, chocolates, smoked meats and spicy dishes.
• foods that cause (legumes, radish, cabbage, carbonated drinks).
• salted and pickled vegetables, mushrooms.
• lard, animal fat.

Better to consume lean fish and meat, vegetarian soups, low-fat cottage cheese, dairy products, various cereals.

The frequency of meals up to 6 times a day in small portions.

Foods prohibited for myocarditis

Salted cucumbers

Medical treatment

Non-steroidal anti-inflammatory drugs (NSAIDs)

Often prescribed by doctors in the treatment of myocarditis. Indeed, they reduce the production of inflammatory factors, reduce myocardial edema. But today there is no unambiguous approach to the appointment of NSAIDs, some clinicians prescribe them, others do not. Basically, they can be used for mild to moderate myocarditis, and in severe cases they are contraindicated, as they can aggravate the course of heart failure.

Mostly from this group of drugs, indomethacin, voltaren, ibuprofen are used. They are administered by intramuscular injection.

Glucocorticosteroids

They are prescribed for myocarditis of moderate and severe severity.

They have strong anti-inflammatory properties. Prednisolone - the main representative of this group, is administered intramuscularly, dosages vary depending on the severity of the process, and treatment can last from 2 to 5 weeks.

Antiplatelet agents and anticoagulants

With myocarditis, platelet deposition in the vessels often increases; for this, antiaggregants (trental) are used to correct these disorders. It is prescribed in tablets.

Heparin (anticoagulant) reduces blood viscosity, is injected subcutaneously.

With myocarditis, it is still necessary to improve metabolism, thereby reducing dystrophic phenomena in the myocardium, for this metabolic therapy is used. In this case, the appointment of riboxin, panangin, adenosine triphosphate (ATP) is possible.

Symptomatic treatment

First of all, we mean the therapy of those clinical manifestations of myocarditis, which are serious complications. Thus, through symptomatic treatment, we eliminate severe violations heart rate, signs of circulatory failure (for example, with swelling of the legs, we prescribe diuretics).

Exercise therapy is prescribed when inflammation in the myocardium begins to decrease. Physical Mode expands very gradually, includes physical exercises training cardio - vascular system. Exercise therapy is carried out by an instructor who controls the pulse and blood pressure.

Observation of patients with myocarditis

After discharge from the hospital, patients are observed by a local therapist for at least one year. Patients visit a doctor once every three months, while an ECG, echocardiography is performed, general and biochemical analyzes blood.

Prevention of myocarditis

Any disease is better to prevent than to cure. So in relation to myocarditis, it is necessary to carry out the prevention of various infections.

During influenza epidemics, you can get vaccinated against this disease. In the autumn-winter period, when there is a high probability of getting ARVI, it is better to drink a course of multivitamins, and if there are already sick people in the team, the doctor will give you advice on taking immunomodulators (kagocel, cytovir).

Use viferon ointment, it is more effective than oxolinic.

It is applied to the mucous membranes of the nose before going outside. Pregnant women can drip into the nose gripferon. Treat chronic lesions infection is also a must.

Prevention of enterovirus infection is the observance of personal hygiene rules, thorough washing of vegetables and fruits under running water.

In conclusion, I would like to add that now, knowing the ways to prevent myocarditis, try to prevent this serious disease.

Video about the prevention of influenza as one of the causes of myocarditis