Carditis symptoms in children. Congenital (intrauterine) carditis

Carditis is an inflammation of the membranes of the heart of various localization and etiology. The disease can affect the epicardium, endocardium, myocardium, as well as the so-called pericardial sac - the pericardium. Currently, the general term "carditis" is used, since the disease can simultaneously affect several layers of the heart.

Carditis: etiology and pathogenesis of the disease

The pathogenesis of carditis is considered as follows: the pathogen enters directly into the tissues of the heart (endocardium, myocardium, epicardium and pericardial sac - pericardium), penetrating into myocytes (a special type of cell that forms the basis of muscle tissue), where it replicates, namely, the reproduction of pathogens mainly due to the protein structures of the cell, which significantly disrupts the functioning of host cells. In response to an infectious lesion, the production of interferon in the body increases, which prevents further damage to the heart tissue. A protracted reaction of the body to the introduction of the pathogen into the heart tissue is extremely rare. In such cases, we are talking about latent, persistent invasion. As a rule, the pathogen is blocked and eliminated in a short time. During the rehabilitation period, an active synthesis of collagen is observed in the affected tissues, which, condensing and turning into fibrous tissue, replaces the foci of necrosis.

Non-rheumatic carditis: classification, differentiation

Non-rheumatic carditis is an inflammation of the membranes of the heart due to various factors, with the exception of rheumatism and other systemic diseases.

Rheumatism is a systemic inflammatory process with the main focus of localization in the membranes of the heart. Rheumatic heart disease is the main manifestation of the rheumatic process in the body.

Non-rheumatic carditis is diagnosed in patients of all age groups and gender. However, more often carditis is diagnosed at an early age. Boys are more at risk of developing carditis.

Modern medical practice provides for the classification of non-rheumatic carditis according to the period of occurrence, type of pathogen, severity, nature of the course, and outcome.

According to the period of occurrence, congenital and acquired carditis are distinguished. Congenital carditis is the result of a viral or bacterial infection transferred by the mother. Early congenital carditis is the result of an illness at 4-7 weeks of gestation. Late congenital carditis develops as a result of infections in the third trimester of pregnancy. Acquired carditis in a child is extremely rare and is the result of an acute infection (sepsis, influenza, pneumonia).

According to the type of course, carditis is distinguished:

• Acute - the duration of the inflammatory process is up to 3 months;
• Subacute - duration of carditis up to 18 months;
• Chronic - lasting more than 18 months.

When diagnosing carditis in children, it is necessary to differentiate with mitral stenosis, congenital heart disease, tumor processes in the heart, rheumatism, arrhythmias of extracardiac origin.

Carditis in children: risks and complications

The outcome of carditis in children depends on many factors, among which are hereditary predisposition, the general condition of the body, the age of the child at the onset of the disease, the state of immunity, the timeliness and effectiveness of the selected therapy.

Possible outcomes of carditis are:

• Complete recovery, which can be judged after 12-18 months from the onset of the disease. In chronic and subacute course of carditis, complete recovery, as a rule, does not occur;
• Arrhythmia is a complication of carditis in children, characterized by a persistent violation of heart rhythms. Often this complication is the cause of death in children with chronic forms of carditis;
• Cardiosclerosis and myocardial hypertrophy - with such complications, carditis in children is characterized by a more severe course, often fatal;
• Pulmonary hypertension is a change in the vessels of the pulmonary artery basin of a persistent nature, which worsens the prognosis of the disease.

Carditis: symptoms of various types

With carditis, the symptoms will depend on the etiology of the disease, the time of its occurrence and the form.

With acquired acute and subacute carditis, symptoms may initially be extracardiac in nature (not due to impaired cardiac function), which include:

• Decreased appetite;
• Lethargy, fatigue, irritability;
• Nausea, vomiting.

The symptomatic complex of carditis can be supplemented by signs of an infection that caused the disease: skin redness and rashes, orchitis, myalgia. In the course of the development of the pathology of carditis, the symptoms are supplemented by signs of heart failure (shortness of breath, tachycardia, arrhythmia). Children at an early age have anxiety, cough. Pain in the region of the heart, which the child cannot yet report, is determined by the child's reaction to the movements of his body (the child reflexively avoids sudden movements, cries during movements), as well as by shallow breathing (movement of the chest during inhalation causes pain, which provokes the child to significantly limit the depth of inspiration). In chronic carditis, symptoms may not appear for a long time. The clinical picture is complemented by a suffocating cough, aggravated in the supine position, purple cyanosis of the cheeks, lips, palms, nails.

Carditis: treatment of the disease

With carditis, treatment requires an integrated approach. His tactics will depend on the causes of carditis, the duration of the disease, the nature of the course of carditis. In acute carditis, treatment must be carried out in a hospital setting. With remissions of carditis, treatment is carried out on an outpatient basis. The main drugs used in the treatment of carditis are cardiac glycosides, diuretics, hormonal drugs. In the acute course of carditis, patients are shown strict bed rest, restriction of fluid intake (its amount should be less than urine excreted), a complete diet with salt restriction and an increase in the proportion of foods containing potassium (potatoes, raisins, dried apricots).

Physical therapy is often used, during periods of remission, on the contrary, physical activity is contraindicated (it is recommended to be exempted from physical education at school, an additional day off).

After suffering carditis, it is contraindicated to carry out preventive vaccinations in the first 3-5 years. With timely diagnosis and the correct tactics of treating carditis, the prognosis is favorable.

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Under carditis understand various kinds of damage to the structures of the heart, due to the development of an inflammatory process in them in its classical manifestation. The level of modern diagnostic capabilities, depending on the localization of the pathological process, makes it possible to make a more accurate diagnosis: pericarditis, myocarditis, endomyocarditis, pancarditis, endocarditis, etc.

The etiology of the disease can be very diverse, while the disease has no connection with the acute form of rheumatic fever or other systemic diseases of the body and diffuse lesions of the connective tissue. In pediatric practice, the expediency of the term "carditis" is due to the possibility of simultaneously affecting all three cardiac membranes (myocardium, endocardium or pericardium) due to the commonality of functions, blood supply and immunopathological reactions.

There are no exact data on the prevalence of the disease among people, which is largely due to the lack of a unified diagnostic approach.

The diagnosis of "non-rheumatic carditis" can be made at any age, but according to statistics, the disease often affects boys in the first years of their lives.

In approximately 5-8% of cases, carditis in children develops as a complication of a viral infection transferred by the child. In some cases, pathology can be provoked by a disease caused by bacteria, allergic reactions, or exposure to toxic substances on the body.

Reasons for the development of carditis

Inflammatory lesions of the heart have a very diverse nature of origin:

• Viral (most often, carditis is provoked by Coxsackie enterovirus types A and B, echoviruses, herpes simplex virus, rubella, cytomegalovirus, etc.);
• bacterial;
• Yersinia (pathogen - a representative of the family of intestinal bacteria Enterobacteriaceae of the genus Yersinia);
• Allergic (moreover, an allergic reaction may be a response to medications, the introduction of a vaccine or serum);
• toxic;
• Idiopathic (which appears, as it were, by itself, for an unknown reason; diseases of unknown etiology account for approximately 10% of the total number of inflammatory lesions of the heart).

In addition, carditis can be caused by exposure to physical agents, radiation, protozoal invasion (malaria, leishmaniasis), fungi, etc.

Classification of non-rheumatic carditis

All carditis is usually classified according to a number of criteria, depending on:

• Development period: the disease can be congenital or acquired. In turn, congenital is divided into early and late;
• Form, which is due to the predominant localization of the pathological process;
• Etiological affiliation;
• The nature of the course of carditis: acute (the duration of the disease does not exceed three months), subacute (the disease lasts from 3 to 18 months) or chronic (the duration of the disease is more than one and a half years). In addition, the course of carditis can be recurrent or primary chronic. In the case of the development of a primary chronic form of the disease, options are also possible: congestive, hypertrophic or restrictive;
• Severity: mild, moderate or severe;
• Forms and severity of heart failure: left ventricular (I, IIA, IIB and III degrees), right ventricular (I, IIA, IIB and III degrees) and total;
• Possible outcome (recovery, death, transition of an acute form to a chronic one) and complications provoked by the disease.

Forms of the course of carditis and their symptoms

Carditis can be congenital or acquired.

Congenital carditis in children is quite rare. Suspicion of the presence of this pathology in a child arises if the condition of the newborn is accompanied by pronounced clinical manifestations of an intrauterine infection, against which many systems and organs are affected. Early congenital carditis in children is a consequence of an acute viral or bacterial infection suffered by the mother in the first months of pregnancy. Late - the consequences of infectious diseases suffered by a woman in the last weeks of gestation.

The course of acquired non-rheumatic carditis is usually divided into three phases:

• acute;
• Subacute;
• Chronic.

Acute carditis appears simultaneously with the development of the underlying disease (for example, influenza) or one to two weeks after recovery. Symptoms of acute carditis are:

• Weakening of heart sounds;
• Pain in the chest and epigastric region;
• increased sweating;
• Moans at night;
• Irritability;
• Change in skin color to grayish-pale;
• An increase in signs of cyanosis of the nasolabial triangle and mucous membranes;
• Wheezing when breathing;
• Systolic murmur, which is accompanied by the passage of blood through the vessels (this symptom is not observed in all cases);
• The expansion of the boundaries of the heart determined by the method of percussion (especially in young children);
• Pathological changes in the cardiogram (pronounced extraordinary contractions of the heart muscle, bradyarrhythmia, impaired blood conduction through the vessels);
• Expansion of the cardiac cavities (mainly the left ventricle).

The subacute form of the disease develops, as a rule, three months after the infection. To a greater extent, this type of disease affects children aged 2 to 6 years. Symptoms of carditis occurring in the subacute form are similar to the manifestations that characterize the acute form, but are less pronounced. And it is for this reason that it is often difficult to determine whether a child has had carditis or not. An accurate diagnosis can only be made on the basis of a number of additional examinations.

The most severe form of the disease is chronic. The diagnosis of "chronic carditis" is made after 1-1.5 years from the end of the cold or in cases where the patient has not been cured of the acute form of the disease. In this case, all the characteristic symptoms of carditis at this stage are preserved, but they are added to:

• swelling of the legs;
• Manifestations of ascites (abnormal accumulation of a large amount of free fluid in the abdominal cavity);
• Significant enlargement of the liver;
• fatigue;
• Weakness;
• Shortness of breath (dyspnea);
• recurrent pneumonia;
• Nausea and vomiting;
• Frequent abdominal pain.

Treatment of carditis

The approach to the treatment of carditis should be comprehensive and phased. In the acute course of the disease, hospitalization is necessary. In this case, the patient is required to appoint:

• Compliance with a diet rich in potassium salts and vitamins;
• Bed rest;
• Oxygen therapy (in severe cases);
• Taking antibacterial drugs.

Further treatment of carditis involves a long-term (usually throughout the year) courses of:

• cardiac glycosides;
• anti-inflammatory drugs;
• Means with a diuretic effect;
• Vitamin therapy;
• Potassium preparations.

In especially severe cases, glucocorticosteroids and antiarrhythmic therapy are indicated.

Patients with heart diseases, including children, are increasingly being admitted to the hospital. Quite common are children's carditis, cardiac pathologies associated with inflammation of the membranes of the heart. Carditis in children, observed from birth, in newborns, older children. It presents with non-specific symptoms. The disease is complex, dangerous, provokes the development of many pathologies, manifested as a result of complications. Inflammation extends to the myocardium, endocardium, epicardium, pericardium.

Depending on the cause of the manifestation, two forms of the disease are distinguished: rheumatic carditis, non-rheumatic. Localization, the degree of damage are directly related to the form of the disease and the causes of its occurrence.

The cause of the rheumatic form of the pathology was systemic autoimmune heart disease (rheumatism). Inflammation covers almost all membranes, first of all, myocardial damage is observed, which provokes the development of pericarditis, endocarditis. Medical statistics indicate that 70% - 80% of young patients undergo pathology. The majority of patients, subject to proper timely treatment, are completely restored, but often the acquired heart disease becomes a consequence of the disease.

Non-rheumatic carditis most often occurs in childhood, provoked by various diseases, including chronic ones:

Along with this, doctors note the fact that sometimes the causes remain unknown, whether they are related to heredity, genetic predisposition, life processes, place of residence, is not yet clear. However, mortality in such a disease ranges from 2.3% to 8%, with viral pathology up to 15%.

Classification

Non-rheumatic children's pathologies according to the degree of damage, the nature of the course, the severity, the period of manifestation, the outcome, are classified into types:

• congenital carditis (early, late);
• acquired.

Congenital pathology can be diagnosed immediately after the birth of a child, in the first days of life. Carditis in newborns appears as a result of the development of intrauterine infection (bacterial, viral), which the mother underwent during pregnancy. A child can acquire pathology after diseases, rheumatic attacks. Depending on how difficult, how long the treatment has become, the pathology is divided into acute (the child is sick for up to 3 months), subacute (18 months), chronic (more than 18 months).

At the initial stage of development, it is difficult to identify children's carditis, the pathology practically does not show symptoms. Inflammation of the heart membranes is difficult to diagnose, so attending physicians should be especially attentive to newborn patients. It is especially difficult to establish carditis if the child has a viral pathology of an infectious nature for a long time. Nevertheless, experts fix some general symptoms, but they are so vague that they can indicate not only a heart disease, but also any other chronic pathology:

• weakness;
• fast fatiguability;
• capriciousness;
• nausea;
• dizziness;
• lack of appetite;
• decreased memory and alertness.

With the development of the disease, the symptoms become more pronounced. In this case, arrhythmia, tachycardia, deafness of the heart tone begin to appear, the child begins to complain of shortness of breath, edema, cynosis, pain in the heart area, and cough are observed. Nevertheless, this also does not indicate the development of carditis, since the symptoms coincide in parallel with the following manifestations of heart disease: arrhythmia, a tumor that affects the myocardium, mitral stenosis, and heart disease.

Diagnostics

By carefully observing a child with heart problems, you can see that he is lethargic and not as active as his peers. Heart diseases of any nature at one stage or another of development in any case provoke the occurrence of pain in the chest area. Children, not even being able to explain their well-being on a subconscious level, try not to perform sudden movements, jumps, breathe shallowly, which suggests that such activity provokes pain.

Doctors, in addition to visual examination, use modern equipment to accurately diagnose the disease:

• ECG, allows you to identify conduction disorders, automatism, indicating hypertrophy of the left heart, myocardial ischemia.
• X-ray reveals how much the forms and tissues of the left ventricle have changed, slowing down the pulsation.

Additionally, in order to determine the treatment, the general condition of the patient is revealed. take blood, urine, do tests for allergens.

Who treats the disease

After birth, often the pathology can be detected immediately, from the maternity hospital by a therapist, the child is sent to the hospital, where the baby is observed by a cardiologist. He also conducts qualified treatment, diagnoses the form of the disease (congenital carditis, acquired), the process of the development of the disease, the prognosis. By identifying the specifics of the disease, a cardiorheumatologist (a narrower specialist) can treat a small patient in the future. The viral origin of carditis is treated by an infectious disease specialist, together with a cardiologist.

Treatment

A complex heart disease such as rheumatic heart disease is treated in children for a long time, in stages. The method of complex treatment is determined primarily on how timely the pathology was detected and how neglected it is. The causes and forms of manifestation of the disease, concomitant chronic diseases, the general condition of the child (psychological, physical) are taken into account.

Acute forms of pathology require immediate hospitalization. The child can stay in the hospital from 10 days to a month. A strict pastel regimen is prescribed, the course of treatment begins with etiotropic antibacterial drugs. Additionally, oxygen therapy can be prescribed when the disease has become neglected and the child is very difficult to tolerate treatment.

The attending physician for rheumatic carditis develops the right diet, specifically for each child. Preference is given to food enriched with vitamins, potassium salts, dried apricots, raisins, baked potatoes. Remove salt from the diet, products that contribute to the formation of edema, those that retain fluid in the body (smoked, salty). Everything harmful is removed from the diet, which is currently contraindicated for the child.

To relieve acute inflammation of the membranes of the heart, in some cases, doctors allow outpatient treatment. About 2 months, anti-inflammatory nonsteroidal drugs, such as Voltaren, Indomethacin, Prednisolone, are prescribed. Additionally prescribe vitamin complexes, antihistamines, potassium. Diuretics, cardiac glycosides can be prescribed. When intravascular blood coagulation is observed, something is prescribed to improve microcirculation, which normalizes metabolic processes in the myocardium.

Depending on the course of the disease, antiarrhythmic therapy, physiotherapy exercises are prescribed, excluding heavy physical exertion. Then the child is sent to recover in health centers, sanatoriums, establishments, cardiological profile. In addition, the attending specialist constantly monitors the child for the next 12 months after treatment, to confirm complete curability, the child undergoes an ECG every three months. For five years after treatment, any preventive vaccinations are prohibited.

Forecast

Given the risk of inflammatory heart disease, the prognosis may depend on:

• what is the age of the child;
• how correctly physical, psychological development proceeds;
• how the immune system works;
• whether there are other chronic diseases;
• what caused, provoked carditis;
• how quickly the pathology was detected;
• Was the treatment correct?
• whether the recommendations of the specialist were observed at the time of recovery;
• whether the child has passed all preventive procedures.

The outcome of treatment also depends on the genetic predisposition, a hereditary factor. For example, often in the acute form of childhood carditis, only after a year or even two, when no more signs of inflammation appear, doctors say that the patient has completely recovered. The disease has passed and there will be no recurrence.

Subacute carditis in children provokes additional health problems. As with chronic pathology, complications arise in the heart, lungs, provoking the development of diseases: cardiosclerosis, arrhythmia, hypertrophy, pulmonary hypertension. Such complications slow down the treatment of the underlying disease, in which case the prognosis can only be bad, up to death.

Prevention

The main preventive measures can be considered everything that does not allow the development of cardiac pathologies. Useful hardening, good physical fitness, proper diet, lack of stress and chronic diseases.

Non-rheumatic carditis- inflammatory lesions of the heart of various etiologies, not associated with rheumatism or other diseases of a systemic nature. The expediency of using the term "carditis" in pediatric practice is justified by the possibility of simultaneous damage to two or three membranes of the heart.

The prevalence of non-rheumatic carditis in the population is not precisely known. This is due to the lack of a unified approach and the great difficulties in diagnosing this pathology. Non-rheumatic carditis is detected in all age groups, but more often in children of the first years of life with a predominance in boys. According to autopsy, non-rheumatic carditis is found in 3-9% of children who died from various causes.

Etiology

Non-rheumatic carditis develops under the influence of various factors, mainly infectious. Among the latter, viruses have a leading role, especially Coxsackie A and B, ECHO. Early and late congenital carditis are the consequences of a viral infection suffered by the mother during pregnancy.

In the origin of non-rheumatic carditis, the bacterial flora, as well as protozoal invasions, fungi, etc., also play a certain role. Damage to the heart can also be caused by an allergic reaction to the administration of drugs, vaccines, sera, the action of various toxic factors, physical agents, and radiation. In some patients (up to 10%), it is not possible to establish the cause that caused the carditis.

Pathogenesis

Non-rheumatic carditis can develop due to the direct cardiotoxic effect of the pathogen with the formation of inflammatory and destructive changes in the membranes of the heart (mainly myocardium). An important role is assigned to immune disorders, often genetically determined. The introduction of an infectious agent leads to the formation of cytotoxic T-lymphocytes, CEC, antibodies to cardiomyocytes, causing the development of allergic reactions of immediate and delayed types. As a result, various structures of the heart (cardiomyocytes, connective tissue, vascular walls) are damaged, metabolic shifts develop, lysosomal enzymes and other mediators are activated, which leads to the destruction of myofibrils, impaired vascular permeability, microcirculation, the occurrence of tissue hypoxia and thromboembolism. The combined action of an infectious agent and immunopathological processes, as a rule, leads to the development of acute carditis. Autoimmune reactions play a decisive role in the development of a chronic process.

Classification

The classification of non-rheumatic carditis used in pediatric practice provides for the allocation of the period of occurrence [congenital (early, late) and acquired], etiological affiliation, the nature of the course (acute, subacute, chronic), severity, severity of heart failure, possible outcomes and complications of the disease.

Clinical picture

The clinical picture of non-rheumatic carditis depends on the period of their occurrence, the nature of the course and the age of the child.

congenital carditis

Congenital carditis can manifest immediately after birth or in the first 6 months of life, less often - in the 2nd-3rd year.

Early congenital carditis manifested by low body weight at birth or its poor increase in the future, rapid fatigue during feeding, unreasonable anxiety, sweating, pallor. Characterized by cardiomegaly, "heart hump", muffled heart tones on auscultation, progressive heart failure (often total with a predominance of the left ventricular), refractory to treatment. Often there is shortness of breath at rest, cough, aphonia, moderate cyanosis (sometimes with a raspberry tint), various moist and wheezing rales in the lungs, liver enlargement, edema or pastosity of tissues. Arrhythmias (with the exception of tachycardia) are rare. The appearance of systolic murmur may be associated with relative or organic insufficiency of the mitral valve, but more often there is no murmur.

On the radiograph, the heart is spherical or ovoid, and with fibroelastosis, it is trapezoidal. The ECG reveals a rigid rhythm, signs of left ventricular hypertrophy due to an increase in myocardial thickness due to infiltration, damage to its subendocardial regions. With fibroelastosis, there are signs of overload of both ventricles, deep Q waves in II and III standard leads, aVF, V 5 , V 6 . With echocardiography, in addition to cardiomegaly and dilatation of the heart cavities, a decrease in the contractile and especially relaxation function of the left ventricular myocardium, valve damage, more often mitral, and pulmonary hypertension are detected.

Late congenital carditis characterized by moderate cardiomegaly, various rhythm and conduction disturbances up to complete transverse heart block and atrial flutter, loud heart sounds, less pronounced (compared to early congenital carditis) heart failure. Often there are signs of damage to two or three membranes of the heart. Some patients experience attacks of sudden anxiety, shortness of breath, tachycardia with increased cyanosis, seizures, which reflects a combined lesion of the heart and central nervous system due to a previous infection, especially caused by Coxsackie viruses.

Acquired carditis

Acquired carditis can occur at any age, but more often in children of the first 3 years of life.

Acute carditis

Against the background of the current or shortly after the infection, lethargy, irritability, pallor, an obsessive cough that increases with a change in body position appear; possible bouts of cyanosis, nausea, vomiting, abdominal pain, encephalitic reactions. Gradually or rather acutely develop symptoms of left ventricular failure (shortness of breath, tachycardia, congestive rales in the lungs). Objectively determine the pulse of weak filling, weakening of the apical impulse, an increase in the size of the heart, mainly to the left, weakening of the first tone, gallop rhythm, various arrhythmias. There is no systolic murmur, but it is possible with the development of insufficiency (relative or organic) of the mitral valve.

X-ray reveals an increase in the size of the heart of various severity, venous congestion in the lungs, a decrease in the amplitude of systolic-diastolic fluctuations, and sometimes an increase in the thymus gland. On the ECG, a decrease in the voltage of the QRS complex, signs of overload of the left or both ventricles, various arrhythmias and conduction disturbances (sinus tachy- or bradyarrhythmia, extrasystole, atrioventricular and intraventricular blockades, ST segment displacement, smoothed or negative T wave are detected. Infarct-like changes and ECG- signs of concomitant pericarditis.On EchoCG, dilatation of the right ventricle and left atrium, hypokinesia of the interventricular septum and the posterior wall of the left ventricle, a decrease in the ejection fraction, an increase in the end-systolic and end-diastolic sizes of the left ventricle, signs of mitral valve insufficiency, effusion in the pericardial cavity are determined.

In young children, the disease is severe, with severe clinical manifestations and progression of heart failure. In older children, carditis usually occurs in a mild or moderate form, with less pronounced symptoms of the disease, rare and less pronounced decompensation, but often accompanied by a variety of rhythm and conduction disturbances, which often determine the clinical picture.

During the treatment of acute carditis, clinical symptoms gradually disappear. Changes on the ECG persist for a longer time. The reverse development of the process occurs after 3 months from its beginning; in addition, carditis can take a subacute or chronic course.

Subacute carditis

Subacute carditis is more common in children aged 2 to 5 years. It can develop either after acute carditis, or independently (primarily subacute carditis) after a long time after SARS, manifesting as pallor, fatigue, irritability, loss of appetite, dystrophy. Gradually (sometimes suddenly) heart failure develops, or arrhythmias, an increase in the size of the heart, and systolic murmur are accidentally detected.

Symptoms of subacute carditis are similar to those of its acute variant. The formation of a "heart hump" is possible, the heart tones are loud, the accent of the II tone over the pulmonary artery is pronounced. On the ECG - signs of overload not only the ventricles, but also the atria, persistent arrhythmias and conduction. Heart failure is difficult to treat. These changes are associated with the duration of the process, the development of compensatory hypertrophy of the left ventricular myocardium, a simultaneous decrease in its contractile function, and the initial manifestations of pulmonary hypertension. The reverse development of the process occurs after 12-18 months, or it acquires a chronic course.

Chronic carditis

Chronic carditis develops more often in children older than 7 years, either in the primary chronic form, or as an outcome of acute or subacute carditis. The clinical picture of chronic carditis is diverse, which is associated, in particular, with the long duration of the disease and the varied ratio of inflammatory, sclerotic and hypertrophic changes in the heart.

The primary chronic variant of non-rheumatic carditis is characterized by a long, asymptomatic course with a predominance of extracardiac manifestations (lagging behind in physical development, weakness, fatigue, decreased appetite, sweating, pallor, recurrent pneumonia). Children often lead a normal life, they can play sports. Periodically there are dizziness, shortness of breath, pain in the heart, palpitations, obsessive cough, nausea, vomiting, pain in the right hypochondrium due to heart failure. Perhaps the acute development of attacks of pallor, anxiety, loss of consciousness, convulsions associated with cardiac decompensation or inflammatory changes in the central nervous system associated with carditis. Often, the assumption of cardiac pathology arises only with the manifestation of cardiac decompensation or the detection of cardiomegaly, persistent arrhythmias, systolic murmur, hepatomegaly during a preventive examination or during examination in connection with an intercurrent disease. Depending on the predominance of cardiosclerosis or myocardial hypertrophy, the following variants of chronic carditis are distinguished: with an enlarged left ventricular cavity - a congestive variant (cardiosclerosis predominates), with a normal left ventricular cavity - a hypertrophic variant, with a reduced left ventricular cavity - a restrictive variant (with or without hypertrophy ).

• In the congestive variant of chronic carditis, a weakening of the apex beat, a significant increase in the size of the heart (mainly to the left) with a progressively increasing "heart hump", persistent arrhythmias, muffled heart tones, systolic murmur of mitral valve insufficiency (usually relative) are observed. Pericardial friction rub or pleuropericardial adhesions may be present. Cardiac decompensation develops gradually or occurs acutely with a predominance of left ventricular failure. On the ECG, a low (less often, excessively high) voltage of the QRS complex, signs of atrial and left ventricular overload, rhythm and conduction disturbances (tachyarrhythmia, extrasystole, atrial fibrillation, atrioventricular blockades of varying degrees), persistent changes in repolarization processes, prolongation of the Q-T interval. The results of the examination (including radiography and echocardiography) indicate a predominant dilatation of the cavity of the left ventricle, relative insufficiency of the mitral valve, impaired pulmonary hemodynamics with symptoms of venous congestion, and a pronounced decrease in the contractile function of the myocardium.
• In chronic carditis with a predominance of myocardial hypertrophy, there is a lag not only in weight, but also in body length. Crimson coloration of the lips and cheeks is revealed, the nail phalanges thicken in the form of "drum sticks", the nails change and take on the appearance of "watch glasses" (a consequence of pulmonary hypertension). The apex beat is strengthened, the I tone at the top is flapping or intensified (muffled tones occur less often), there is a sharp accent of the II tone over the pulmonary artery, there is bradycardia. The borders of the heart remain normal for a long time, the "heart hump" is not always expressed. Heart murmurs are absent or due to changes in the bi- or tricuspid valve. Left ventricular failure is joined by right ventricular failure, which further determines the nature of decompensation: peripheral edema, ascites, hepatomegaly, and dystrophic changes on the skin of the legs appear. In this variant of chronic carditis, the ECG reveals persistent conduction disturbances of various localization (rhythm disturbances, with the exception of bradycardia, are uncharacteristic), signs of subendocardial hypoxia. Examination (EchoCG, X-ray, etc.) reveals atriomegaly, increased pressure in the pulmonary artery system with venous congestion and possible interstitial pulmonary edema, dilatation of the right ventricle (a consequence of pulmonary hypertension), symmetrical or asymmetric myocardial hypertrophy. The size of the cavity of the left ventricle is normal or slightly reduced. The mitral valve is not changed. With the progression of the process, the contractile function of the myocardium gradually decreases, but the violation of relaxation remains decisive.

Diagnosis of non-rheumatic carditis in children

Diagnosis of non-rheumatic carditis often presents certain difficulties. It is based on the identification of clinical and instrumental signs of heart damage, mainly myocardium, anamnestic data (establishing a connection between the development of the process and a previous infection, especially a viral one), the exclusion of diseases similar in symptoms, dynamic monitoring and evaluation of the effectiveness of therapy. It is also necessary to take into account the level of physical development of the child and the presence of various unmotivated persistent disorders of well-being.

Even more difficulties arise in the diagnosis of rarely developing congenital carditis. Convincing evidence of fetal exposure to an infectious agent, identification of a generalized infection with reliable laboratory confirmation of it, and the use of all available diagnostic methods, including endomyocardial biopsy, are required.

Differential Diagnosis

The list of diseases with which differential diagnosis of non-rheumatic carditis is carried out depends on the age of the child and the form of carditis.

• In newborns and young children, non-rheumatic carditis, especially congenital ones, must be differentiated from congenital heart defects, in particular, with an incomplete form of atrioventricular communication, Ebstein anomaly, and abnormal origin of the left coronary artery from the pulmonary artery. Common symptoms of non-rheumatic carditis and these malformations include retardation in physical development, cardiomegaly, rhythm and conduction disturbances, heart murmurs, signs of circulatory failure, as well as various complaints of a cardiac and extracardiac nature. Unlike non-rheumatic carditis, with congenital heart defects there is no connection with a previous infection, damage to the right heart is predominant, pulmonary hemodynamics are disturbed (depletion of the pulmonary pattern or its strengthening); there are other individual characteristics of each vice. Echocardiography and other special research methods are of decisive importance in differential diagnosis.
• In newborns, changes in the heart, resembling non-rheumatic carditis, may occur due to perinatal hypoxia. In this case, cardiomegaly, muffled heart tones, rhythm and conduction disturbances, sometimes heart murmurs and symptoms of circulatory failure are possible. The study of anamnesis, the presence of neurological symptoms, the transient nature of cardiac changes make it possible to exclude the diagnosis of congenital carditis.
• In older children, non-rheumatic carditis must be differentiated from rheumatism, arrhythmias of extracardiac origin, myocardial dystrophy, etc.
  • Rheumatism, in contrast to acute or subacute variants of carditis, is characterized by a connection with a previous streptococcal infection, polyarthritis, chorea minor, and specific laboratory changes. It usually develops in children over 7 years of age, is characterized by a combined lesion of the endo- and myocardium (with non-rheumatic carditis, myocardial insufficiency predominates) with the possible formation of heart disease.
  • Arrhythmias in children are often caused by vegetative disorders, for example, those associated with perinatal damage to the central nervous system (in the anamnesis - an unfavorable course of pregnancy and childbirth). These children often have focal neurological symptoms, hypertensive-hydrocephalic syndrome; there are no objective signs of cardiac pathology. Characterized by the variability of symptoms.
  • Myocardial dystrophy, as a rule, is characterized by a paucity of complaints and mild clinical manifestations: the size of the heart is usually normal, heart sounds are of normal sonority or are slightly muffled. Heart failure is rare. The identification of etiological factors (endocrine pathology, foci of chronic infection, intoxication, etc.), the conduct of appropriate pharmacological tests, the disappearance of symptoms during the treatment of the underlying disease speak in favor of myocardial dystrophy.
  • In some patients, non-rheumatic carditis, especially chronic, should be differentiated from cardiomyopathies, in particular, hypertrophic cardiomyopathy. With this form of cardiomyopathies, often of a familial nature, there is usually no connection with a past infection, there are systolic murmurs of different timbre and localization (subvalvular aortic stenosis and mitral valve insufficiency), asymmetric hypertrophy of the muscular part of the interventricular septum with its preserved contractile ability. The cavities of the left atrium and left ventricle are normal or slightly enlarged.

Additionally, non-rheumatic carditis in children must be differentiated from congenital conduction disorders, mitral valve prolapse, cardiac changes in storage diseases, hereditary connective tissue diseases, constrictive pericarditis, and heart tumors. Symptoms similar to those in non-rheumatic carditis also appear with functional cardiovascular disorders, manifested by autonomic dystonia syndrome, changes in the ST segment and T wave on the ECG, and some other conditions (long QT interval syndrome, primary pulmonary hypertension, various formations in the mediastinum ).

Treatment

Treatment for non-rheumatic carditis depends on its etiology, variant, period of the disease, the presence or absence of circulatory failure. Treatment is carried out in two stages.

• At the first stage (hospital), physical activity is limited, a diet enriched with vitamins and potassium salts is prescribed, and a drinking regimen is established. Bed rest for 2-4 weeks is prescribed for acute or subacute carditis, as well as for exacerbation of a chronic one. The expansion of the motor regime should be carried out gradually, under the control of the functional state of the cardiovascular system and ECG dynamics. Mandatory exercise therapy. Drug therapy includes the following drugs.
  • Non-steroidal anti-inflammatory drugs (NSAIDs) - indomethacin, diclofenac and others for 1 - 1.5 months.
  • In severe, widespread process, high degree of activity, predominant damage to the conduction system of the heart - glucocorticoids (prednisolone at a dose of 0.5-0.75 mg / kg / day).
  • With a protracted and chronic course of carditis - aminoquinoline derivatives (hydroxychloroquine, chloroquine).
  • In heart failure - cardiac glycosides, ACE inhibitors, diuretics, vasodilators, etc.
  • Mandatory correction of metabolic disorders in the myocardium, microcirculatory disorders is carried out, according to indications, anticoagulants, antiaggregants, antiarrhythmic drugs are prescribed.
  • With an established etiological factor (viruses, bacterial flora) - antiviral (Ig, interferon) and antibacterial drugs, immunostimulants.
• At the second stage (after discharge from the hospital), the child needs to continue treatment and carry out rehabilitation measures in a local cardio-rheumatological sanatorium. Subsequently, children with carditis are observed by a cardiorheumatologist at the place of residence. Clinical examination of patients who have undergone acute or subacute carditis is carried out until complete recovery (on average 2-3 years), and with congenital and chronic variants - constantly. The regularity of control, the scope of studies (X-ray, ECG, EchoCG) is determined individually. During the observation period in the clinic, if necessary, the treatment is corrected, drugs that stimulate metabolic processes are prescribed, and foci of chronic infection are sanitized. Preventive vaccinations can be carried out after suffering acute or subacute carditis no earlier than 3 years later; in the presence of a chronic process, vaccination is contraindicated.

Prevention

Primary prevention includes prevention of infection of the fetus during pregnancy, hardening of the child, treatment of acute and chronic focal infection, dispensary monitoring of children at risk for cardiovascular diseases. Secondary prevention is aimed at preventing complications and recurrence of the process, achieved by strict adherence to the principles of dispensary observation of patients.

Forecast

The prognosis of non-rheumatic carditis depends on its variant.

• Early congenital carditis is usually severe and often leads to death in the first years and even months of life.
• With late congenital carditis, with adequate and timely prescribed therapy, the process can become chronic without progression of cardiac changes; recovery is possible.
• The acute variant of carditis in 44.1% of children ends in recovery, in about 50% of patients it acquires a subacute or chronic course and rarely (in 2.2% of cases) leads to death with a slowly, gradually developing process, persistent arrhythmias.
• Subacute carditis proceeds less favorably with a higher mortality (up to 16.6%), is resistant to therapy and often transitions to a chronic variant.
• In chronic carditis, the prognosis is also often unfavorable, especially with the development of cardiosclerosis, progressive heart failure, pulmonary hypertension, persistent rhythm and conduction disturbances that can lead to the formation of arrhythmogenic cardiomyopathy. The presence of arrhythmias can cause sudden death of children not only with chronic carditis, but also with its other variants.

Original article

In this article, we will tell you in detail about the development and diagnosis of congenital carditis.

Intrauterine (congenital) carditis in newborns

Sometimes it is detected even in the antenatal period, but more often it is diagnosed in the first weeks and months of life, usually in connection with acute heart failure. There are early and late congenital carditis.

Early carditis occurs during the month of fetal life and is manifested by the intensive development of elastic and fibrous tissue in the subendocardial layers of the myocardium without clear signs of inflammation (fibroelastosis, elastofibrosis). Sometimes chords and valvular apparatus are also involved in the process, which leads to the occurrence of heart defects.

Late carditis occurs after the 7th month of intrauterine life. They are characterized by distinct inflammatory changes in the myocardium without the formation of elastic and fibrous tissue.

The anamnesis almost always contains indications of acute or chronic infectious diseases of the mother during pregnancy. Clinical and instrumental-graphic signs and the nature of its course are very similar to a severe form of chronic non-rheumatic carditis. From the latter, congenital carditis in newborns differs in its early manifestation, steadily progressive course, and resistance to ongoing therapy.

An x-ray examination of the chest shows a spherical or ovoid shape of the shadow of the heart, its emphasized waist, a narrow vascular bundle (with late carditis, the heart has a trapezoid shape); there is a sharp decrease in the amplitude of the pulsation of the left ventricle.

On the ECG, sinus tachycardia, high voltage of the QRS complex, signs of left ventricular hypertrophy with deep Q waves and subendocardial hypoxia of the myocardium are recorded, often - overload and hypertrophy of the right ventricle. the diagnosis of fibroelastosis can be confirmed by a morphological study of biopsies of the heart muscle and endocardium obtained during cardiac probing.

Congenital late carditis

It is characterized by moderate cardiomegaly, various arrhythmias and conduction disorders up to complete transverse heart block and atrial flutter, loud heart sounds, and less pronounced (compared to early congenital carditis) heart failure. Often there are signs of damage to two or three membranes of the heart. Some newborns experience attacks of sudden anxiety, shortness of breath, tachycardia with increased cyanosis, seizures, which reflects a combined lesion of the heart and central nervous system due to a previous infection, especially caused by Coxsackie viruses.

Congenital early carditis

Congenital carditis in newborns in the early form is manifested by low birth weight or its poor increase in the future, fatigue during feeding, unreasonable anxiety, sweating, pallor. Characterized by cardiomegaly, "heart hump", muffled heart tones on auscultation, progressive heart failure (often total with a predominance of the left ventricular), refractory to treatment. Newborns often have:

• shortness of breath at rest
• cough,
• aphonia,
• moderate cyanosis (sometimes with a raspberry tint),
• various wet and whistling rales in the lungs,
• liver enlargement,
• swelling or pastosity of tissues.

Arrhythmias (with the exception of tachycardia) are rare. The appearance of systolic murmur may be associated with relative or organic insufficiency of the mitral valve, but more often there is no murmur.

On the radiograph, the heart is spherical or ovoid, and with fibroelastosis, it is trapezoidal. With congenital carditis in newborns, the ECG reveals a rigid rhythm, signs of left ventricular hypertrophy due to an increase in myocardial thickness due to infiltration, damage to its subendocardial sections. With fibroelastosis, there are signs of overload of both ventricles, deep Q waves in II and III standard leads, aVF, V 5 , V 6 . With echocardiography, in addition to cardiomegaly and dilatation of the heart cavities, a decrease in the contractile and especially relaxation function of the left ventricular myocardium, valve damage, more often mitral, and pulmonary hypertension are detected.

Carditis

Carditis is an inflammatory disease of the heart of various etiologies that is not associated with rheumatism or other systemic diseases. In pediatrics, the expediency of using the term "carditis" is justified by the possibility of simultaneous damage to two or three membranes of the heart (endo-, myo- or pericardium).

To date, non-rheumatic carditis is diagnosed by specialists in all age groups, but mainly in children of the first years of life. According to autopsy data, this disease is found in 3-9% of children who died from various causes.

Carditis results from the action of various factors, often infectious, among which the main pathogens are scarlet fever, diphtheria and tonsillitis, as well as Coxsackie, rubella and influenza viruses.

In addition, non-rheumatic carditis are congenital (early and late). Early congenital carditis develops in those children whose mothers had an acute viral or bacterial infection at 1-2 months of pregnancy. In turn, late congenital carditis in children occurs due to infectious diseases that a woman has in the last weeks of pregnancy.

Congenital carditis is relatively rare. This pathology can be suspected if the condition of the newborn is characterized by pronounced symptoms of an intrauterine infection, which is accompanied by damage to many systems and organs.

Bacterial flora, protozoan invasions and fungi play a certain role in the development of non-rheumatic carditis. In addition, the disease may be the result of an allergic reaction to the administration of drugs, serums, vaccines, and also occur under the influence of various toxic factors, radiation, and physical agents.

Modern pediatric practice distinguishes the following types of carditis in children:

• congenital and acquired (depending on the period of occurrence);
• acute, subacute and chronic (based on their etiological affiliation and the nature of the course).

In addition, the severity of heart failure, the severity of the pathology, as well as possible complications and outcomes are taken into account.

Disease pathogenesis

Non-rheumatic carditis develops as a result of the direct cardiotoxic effect of the pathogen with the formation of destructive and inflammatory changes in the membranes of the heart muscle. As a result of the introduction of an infectious agent, cytotoxic T-lymphocytes, antibodies to cardiomyocytes, CEC are formed, which cause allergic reactions. As a result, various structures of the heart undergo destructive changes, which causes:

• violation of its microcirculation and vascular permeability;
• destruction of myofibrils;
• the occurrence of thromboembolism and tissue hypoxia.

The combined influence of immunopathological processes and an infectious agent mainly cause the development of acute carditis. As for the chronic process, autoimmune reactions play a key role in it.

Symptoms of carditis in children

The clinical picture of the disease depends on the age of the patient, the individual characteristics of the organism, as well as on the nature of the course of the disease. Acute non-rheumatic carditis usually develops in children of the first three years of life as a result of a viral infection. Symptoms of acute carditis include:

• manifestations of intoxication (pallor, fatigue, sweating, loss of appetite, a slight increase in body temperature, etc.);
• pain in the region of the heart;
• weak, rapid, often arrhythmic pulse;
• expanding the boundaries of the heart;
• lowering blood pressure;
• violation of the rhythm of cardiac activity, the presence of systolic murmur;
• pericarditis (in some patients).

In addition, signs of acute heart failure with tachycardia, shortness of breath, cyanosis of the mucous membranes, palpitations, enlarged liver, congestive rales in the lungs, and swelling of the extremities can also join the symptoms of carditis in a short period of time.

During the treatment of carditis, the clinical symptoms gradually disappear, and the reverse development of the pathological process occurs 3 months after its onset. In addition, carditis can take a subacute or chronic course.

Subacute carditis is predominantly observed in children aged 2 to 5 years. This form of the disease occurs either after acute carditis, or independently after a long time after SARS.

Symptoms of subacute carditis are:

• manifestations of intoxication (pallor, fatigue, irritability, etc.)
• dystrophy;
• heart failure, which develops gradually;
• arrhythmias, systolic murmur;
• enlargement of the heart.

In general, the manifestations of subacute disease are similar to the symptoms of acute carditis, but therapy is difficult because the resulting heart failure is caused by long-term destructive changes. As experts point out, the reverse development of the process can take place after 1-1.5 years, or subacute carditis becomes chronic.

As for the congenital forms of non-rheumatic carditis in children, they occur either immediately after birth or in the first six months of life.

Symptoms of early congenital carditis are:

• small body weight at birth;
• fast fatigue during feeding;
• causeless anxiety;
• sweating, pallor;
• cardiomegaly, muffled heart sounds;
• "heart hump" (protrusion of the heart area);
• progressive heart failure.

In addition, the manifestations of congenital non-rheumatic carditis in children include:

• frequent shortness of breath at rest;
• cough, aphonia;
• moderate cyanosis;
• liver enlargement;
• wheezing and moist rales in the lungs;
• edema (pastosity of tissues).

As for late congenital carditis, it is characterized by:

• violations of the rhythm and conduction of the heart;
• moderate cardiomegaly;
• loud heart sounds
• mild heart failure.

With this form of the disease, specialists often observe symptoms of damage to two or even three layers of the heart. If untreated, this form of carditis is complicated by attacks of sudden anxiety, shortness of breath, tachycardia, cyanosis, and convulsions.

Prognosis and treatment of carditis

Treatment of carditis is complex and staged. In the acute period of the disease, therapy in a hospital is necessary. Bed rest and a diet enriched with potassium salts and vitamins are important; oxygen therapy is indicated in severe forms of the disease. At the beginning of the treatment of carditis, antibacterial agents must be prescribed. And throughout the year, a course of therapy with cardiac glycosides, anti-inflammatory and diuretic drugs, as well as vitamins and potassium is carried out. In severe cases, corticosteroids are used and antiarrhythmic treatment is performed.

The outcome of this pathology in young children may be cardiosclerosis or myocardial hypertrophy, sometimes there is adhesive pericarditis, sclerosis in the pulmonary artery system or valvular disease (with a complicated course). In patients older than 3 years, the disease often ends in complete recovery.

This article is posted for educational purposes only and does not constitute scientific material or professional medical advice.

Carditis in children as a result of infection

Carditis (carditis) is a disease associated with myocardial damage, which manifests itself in almost 8% of newborns. The non-rheumatic form in children belongs to the category of inflammatory cardiac complications. According to medical statistics, cases of manifestations are increasing and often occur in a severe form, turning into a chronic condition. Based on these data, the non-rheumatic type is considered to be an important problem faced by children's cardiology centers. Carditis can provoke the development of serious cardiovascular pathological courses in middle age.

Carditis in children is infectious in nature and is complicated by exposure to various bacterial infections. The disease is also directly associated with allergic reactions of various nature. In a large number of patients, it becomes impossible to identify the cause of the disease. Against the background of the course of the disease in a child, several possible lesions of the heart tissue are detected:

• Inflammatory-infiltrative;
• dystrophic;
• With the involvement of the coronary vessels;
• With the involvement of the conducting system;
• mixed;

The clinical picture is determined by the age of the sick child, the individual characteristics of his body and the nature of the course of the disease.

Acute non-rheumatic type and its symptoms

The development of this form begins in the first two years of life on the basis of a previous or existing viral infection. Symptoms of carditis at different stages are pronounced - pale skin, increased sweating and fatigue, slight fever, lack of appetite. Often, against the background of general signs, there is an urge to vomit, pain in the abdomen (like appendicitis). The child's condition often worsens, arrhythmia appears, changes begin in the boundaries of the heart. Devices for measuring blood pressure show reduced numbers.

Acute carditis is accompanied by persistent cardiac arrhythmia, muffled heart sound and systolic murmur. An intense and continuous murmur indicates damage to the mitral valve or endocardium. In some patients, these symptoms may also indicate the development of pericarditis. For a short period of time, the child develops ventricular failure, accompanied by bouts of shortness of breath and wheezing in the lungs. Carditis provokes an increase in the walls of the liver, and when diagnosed, rheumatological tests show a normal result. After the x-ray, the doctor notes the enlarged size of the heart with various changes in the heart tissue.

Chronic form in children

It occurs in children over the age of three. The symptoms of the primary chronic process are not too pronounced, so carditis at this stage can proceed in a latent form, in contrast to a disease such as halitosis, which manifests itself almost immediately. With a mild course, there are no complaints from the patient. It is possible to recognize the disease after the onset of symptoms indicating heart failure or during a random examination. Patients under the influence of the disease sometimes lag behind in physical development. Symptoms as it progresses are fatigue, shortness of breath, intermittent chest pain, cough, and rapid heart rate. When diagnosed on the ECG, a violation of the heart rhythm and a decrease in myocardial activity, hypertrophy of the left ventricle (less often the right one) are clearly expressed.

early congenital type

Congenital carditis occurs in utero. It begins to appear already at 4-7 months of fetal life. Elastic and fibrous tissue develops in the myocardium. There are no clear signs of inflammation. Often, violations affect the valvular apparatus. Such a course can cause various heart defects, and ventriculomegaly can aggravate the situation. The anamnesis indicates the transferred infectious diseases by the mother during the bearing of the child. Symptoms of early carditis and its nature is similar to the severe stage of recurrent carditis. Many patients show resistance to therapy. The baby is characterized by lethargy, increased sweating, deformity in the chest area and developmental delay from the first days after birth.

Treatment

Elimination of the disease is carried out in a complex and phased manner. In the case of an acute course, the patient needs to be treated in a stationary mode. Bed rest is prescribed. Throughout the year, the child undergoes therapy, which includes anti-inflammatory drugs and antihistamines. The main group of drugs - cardiac glycosides, diuretic, vitamin complex. With severe indications, a hormonal corticosteroid course is started. Treatment is aimed at eliminating the arrhythmia. Along with drugs, children are prescribed physiotherapy exercises, sanitation of foci of chronic infection and hardening courses.

Treatment gradually turns into a sanatorium mode. Patients are under the supervision of a doctor for up to five years in a dispensary or cardiology office. The attending physician conducts a scheduled examination and ECG. A child with carditis is exempted from preventive vaccinations. With the possible development of cardiosclerosis, the patient is observed until reaching adolescence. During this period, planned treatment is carried out to improve myocardial trophism.

Preventive measures to prevent the disease

• Treatment of infectious diseases and toxicosis of a pregnant woman
• Choosing the Right Diet
• Elimination of factors that provoke allergic reactions

The risk group includes children with heredity of cardiac pathologies, impaired immunity and myocardial dystrophy.

Myocarditis in newborns: causes, symptoms and treatments

There is nothing worse for parents than the illness of their child, and if a newborn is sick, it is doubly difficult. Almost all diseases in infants are generalized (with damage to many organs and systems) and severe, and the compensatory mechanisms of a small organism are significantly reduced.

Myocarditis is a topical issue of modern pediatrics and obstetrics. This lesion can occur on its own, but is more often a symptom of a common viral infectious disease. In some cases, myocarditis is diagnosed even in the antenatal period (before delivery with the help of ultrasound) and often determines obstetric tactics and further management of a sick child.

What is myocarditis and what causes it in infants?

Myocarditis is an inflammatory lesion of the heart muscle (myocardium), in which muscle tissue is infiltrated by inflammatory immunocompetent cells. Such damage to the heart can manifest itself with a wide variety of clinical symptoms: from minimal manifestations to fatal lesions with a fatal outcome.

The frequency of myocarditis in newborns according to statistics is 1 child in 80 thousand. Rarely, myocardial damage occurs in isolation, most often the disease is combined with encephalitis or hepatitis.

There are three types of myocarditis in newborns:

• early antenatal myocarditis - caused by a viral infection that persists in the body of a pregnant woman in the early stages of pregnancy (rubella, herpes virus, etc.), by the beginning of childbirth, the active inflammatory process in the heart ends and the child is diagnosed with cardiomyopathy;
• late antenatal myocarditis - caused by viruses that infect the fetus in the last trimester of pregnancy, in which case the child is born with signs of active inflammation in the heart and a clinic of myocarditis (congenital myocarditis);
• acute postnatal myocarditis develops when a child is infected with a viral infection after childbirth, in the first days of life, most often the infection occurs from the mother or medical staff.

The cause of late antenatal and acute postnatal myocarditis can be any viral infection.

Most often, the disease is caused by:

• Coxsackie A and B viruses;
• ECHO viruses;
• enteroviruses;
• adenoviruses;
• herpetic infection;
• influenza virus;
• polio virus;
• hepatitis viruses;
• Epstein-Barr virus;
• parvovirus B19;
• cytomegalovirus, etc.

Very often, the disease occurs in the form of a generalized lesion of the heart (endocardium, myocardium and pericardium), and not just the muscular membrane of the heart. In this case, the term carditis is used to refer to the disease.

What happens to the baby's heart with myocarditis?

The main danger of myocarditis is the development of acute or chronic heart failure in a child. After the viruses enter the baby's blood, they are fixed on the muscle cells of the heart, and also penetrate inside. This is the initial stage of the disease, which does not last long (from several hours to several days). At this stage, the protective mechanisms of the immune system are activated and specific antibodies are produced that destroy viral particles and cells affected by the virus.

If, for any reason, the persistence of viral DNA or RNA is delayed in myocardiocytes, then antibodies against myocardial cells with the genetic material of the pathogen begin to be produced and autoimmune heart damage occurs.

These inflammatory processes damage the contractile elements of myocardiocytes, which ultimately affects the contractility of the heart - it decreases significantly, and the heart chambers expand. Compensation occurs due to a significant increase in heart rate, and pressure is maintained due to the centralization of blood circulation. But such a state does not last long, since the infant has few compensatory possibilities. The chambers of the heart expand and heart failure progresses rapidly.

Symptoms of myocarditis in infants

Clinical manifestations of myocardial inflammation are very variable, depending on the duration of infection, the type of viral infection, concomitant lesions of organs and systems, and the severity of the pathological process.

The true prevalence of myocarditis is not known because only one in five cases have been reported. From this we can conclude that most myocarditis is asymptomatic and has no consequences.

In other cases, the following symptoms of myocardial damage are observed:

• progressive excessive heartbeat (tachycardia);
• increased breathing with healthy lungs, which indicates damage to the heart;
• pallor of the skin;
• retraction of the intercostal spaces during breathing and the participation of other additional respiratory muscles in the act of breathing;
• development of various cardiac arrhythmias;
• clinical symptoms of the infection that caused myocarditis (stool disorders, vomiting with enterovirus infection or respiratory symptoms with adenovirus infection);
• syndrome of depression of the central nervous system (drowsiness, inhibition of reflexes and other manifestations);
• diarrhea, jaundice, etc.

Diagnosis of myocarditis in newborns

Correctly collected anamnesis (including obstetric) and an objective examination of a newborn child are important for establishing a diagnosis.

When examining a child, the doctor will establish transcendental tachycardia, weakening of heart tones, the appearance of additional heart sounds, heart murmurs, arrhythmias, and wheezing in the lungs. These symptoms indicate heart damage and the development of heart failure, allow the doctor to build a plan for examining the child and outline a treatment program.

To establish the diagnosis of myocarditis, the following examinations are used:

• laboratory methods for examining blood and urine (signs of an inflammatory process);
• detection of the causative agent of myocarditis (isolation of the virus from blood, feces, nasopharyngeal swabs, determination of antibodies to viruses and the genetic material of the pathogen - PCR diagnostics);
• ECG (low voltage and other characteristic manifestations of myocarditis);
• echocardiography - allows you to determine the size of the chambers of the heart, their expansion, a decrease in myocardial contractility and ventricular ejection fraction, allows you to exclude congenital malformations of the cardiovascular system, which also manifest similar clinical symptoms;
• x-ray examination of the chest organs - an increase in the heart in the pictures;
• determination of markers of myocardial damage - the enzyme lactate dehydrogenase, aspartate aminotransferase, creatine phosphokinase (MB-fraction), troponin I.

In most cases, these examination methods are sufficient to establish the diagnosis of myocarditis, but sometimes it is necessary to resort to other, more invasive, diagnostic methods (endomyocardial biopsy).

Principles of treatment of myocarditis in infants

Treatment should be started as early as possible and only in a hospital setting. The main treatment is aimed at eliminating the causes of myocarditis and signs of heart failure.

As a rule, in viral etiology of myocarditis, specific therapies are not very effective. In the literature, there are indications of a good effect of alpha-interferon and other antiviral agents.

Despite the widespread use of non-steroidal anti-inflammatory drugs in clinical practice, their effectiveness in myocardial inflammation has not been proven. Moreover, there is experimental evidence that salicylates, indomethacin and ibuprofen increase the replication of viral particles in the myocardium, which makes the course of the disease more severe, which affects the increase in mortality in experimental animals.

It is advisable to prescribe glucocorticoid hormones only in severe lesions, which are accompanied by severe heart failure or dangerous cardiac arrhythmias.

The basis of therapy is inotropic support of the heart (cardiac glycosides, dopamine, dobutamine). Assign diuretics to combat the stagnation of fluid in the body. Antiarrhythmic drugs are prescribed only for strict indications, when the arrhythmia is life-threatening.

With a favorable course, the pathological process slowly regresses and recovery occurs. But sometimes the damage is too great and mortality in such severe myocarditis in the first few days of a child's life reaches 75%.

Non-rheumatic carditis in children - inflammatory lesions of one or more membranes of the heart, not associated with rheumatic or other systemic pathology. The course of non-rheumatic carditis in children is accompanied by tachycardia, shortness of breath, cyanosis, arrhythmia, heart failure, and lag in physical development. When diagnosing non-rheumatic carditis in children, clinical, laboratory, electrocardiographic, radiological data are taken into account. In the treatment of non-rheumatic carditis in children, cardiac glycosides, NVPS, hormones, diuretics, metabolic, antiviral and antimicrobial drugs are used.

Non-rheumatic carditis in children

Non-rheumatic carditis in children is a group of inflammatory heart diseases, mainly of infectious-allergic etiology. The expediency of isolating non-rheumatic carditis in pediatrics is due not only to isolated, but often combined lesions of the 2nd and 3rd membranes of the heart in children. Among non-rheumatic carditis in pediatric cardiology, there are myocarditis, pericarditis, endocarditis, as well as myopericarditis and pancarditis. The true prevalence of non-rheumatic carditis in the pediatric population is unknown; according to autopsy, pathology is found in 3-9% of children. Children of different age groups suffer from non-rheumatic carditis, however, young children, mostly boys, predominate among them.

Causes of non-rheumatic carditis in children

Non-rheumatic carditis in a child may be due to infectious or allergic-immunological factors. Among infectious agents, viruses predominate (ECHO, Coxsackie A and B, adenoviruses, influenza viruses type A or B), there are bacteria (streptococci, staphylococci), rickettsia, fungi, associated flora. The cause of congenital carditis in a child is intrauterine infections that affect the fetus. Bacterial non-rheumatic carditis in children is often a complication of nasopharyngeal infection, sepsis, hematogenous osteomyelitis, diphtheria, salmonellosis.

Carditis of allergoimmunological etiology can develop as a result of vaccination, administration of sera, and medication. Quite often, the infectious-allergic nature of heart damage is traced. In about 10% of children, the etiology of non-rheumatic carditis remains unclear.

Predisposing factors against which the viral-bacterial microflora is activated, susceptibility to toxins and allergens increases, immunological reactivity changes, intoxications, infections suffered by the child, hypothermia, psycho-emotional and physical overload, previous surgical procedures on the heart and blood vessels, thymomegaly. In some children with non-rheumatic carditis, hereditary disorders of immune tolerance are found.

Classification of non-rheumatic carditis in children

Taking into account the time factor, carditis is divided into congenital (early and late) and acquired. According to the duration, the course of carditis can be acute (up to 3 months), subacute (up to 18 months), chronic (more than 18 months); according to severity - mild, moderate and severe.

The outcome and complications of non-rheumatic carditis in children can be recovery, heart failure (left ventricular, right ventricular, total), myocardial hypertrophy, cardiosclerosis, rhythm and conduction disturbances, thromboembolism, pulmonary hypertension, constrictive pericarditis, etc.

Symptoms of non-rheumatic carditis in children

congenital carditis

Early congenital non-rheumatic carditis usually manifests immediately after birth or in the first six months of life. The child is born with moderate malnutrition; from the first days of life, he has lethargy and fatigue during feeding, pallor of the skin and perioral cyanosis, unreasonable anxiety, sweating. Tachycardia and shortness of breath, expressed at rest, are further aggravated by sucking, crying, defecation, bathing, swaddling. Children with congenital non-rheumatic carditis early and noticeably lag behind in weight gain and physical development. Already in the first months of life, cardiomegaly, heart hump, hepatomegaly, edema, heart failure refractory to therapy are detected in children.

The clinic of late congenital non-rheumatic carditis in children develops at 2-3 years of age. Often occurs with damage to 2 or 3 membranes of the heart. Signs of cardiomegaly and heart failure are less pronounced than in early carditis, however, the clinical picture is dominated by the phenomena of rhythm and conduction disturbances (atrial flutter, complete atrioventricular heart block, etc.). The presence of a convulsive syndrome in a child indicates an infectious lesion of the central nervous system.

Acquired carditis

Acute non-rheumatic carditis often develops in young children against the background of an infectious process. Nonspecific symptoms are characterized by weakness, irritability, obsessive cough, bouts of cyanosis, dyspeptic and encephalitic reactions. Acute or gradual left ventricular failure occurs, characterized by shortness of breath and congestive wheezing in the lungs. The clinical picture of non-rheumatic carditis in children is usually determined by various rhythm and conduction disorders (sinus tachycardia or bradycardia, extrasystole, intraventricular and atrioventricular blockades).

Subacute carditis is characterized by fatigue, pallor, arrhythmias, and heart failure. Chronic non-rheumatic carditis is usually characteristic of school-age children; proceeds oligosymptomatically, mainly with extracardiac manifestations (weakness, fatigue, sweating, lag in physical development, obsessive dry cough, nausea, abdominal pain). Recognition of chronic carditis is difficult; children are often treated for a long time and without results by a pediatrician with diagnoses of "chronic bronchitis", "pneumonia", "hepatitis", etc.

Diagnosis of non-rheumatic carditis in children

Recognition of non-rheumatic carditis in children should take place with the mandatory participation of a pediatric cardiologist. When taking an anamnesis, it is important to establish the relationship of the manifestation of the disease with a previous infection or other possible factors.

A combination of clinical and instrumental data helps to make a diagnosis of non-rheumatic carditis in children. Electrocardiography in carditis does not show any pathognomonic signs; Usually, children have long-term cardiac arrhythmias, AV blockade, bundle branch block, signs of hypertrophy of the left heart.

Chest x-ray reveals cardiomegaly, changes in the shape of the heart shadow, increased pulmonary pattern due to venous congestion, signs of interstitial pulmonary edema. The results of ultrasound of the heart in a child demonstrate dilatation of the heart cavities, a decrease in the contractile activity of the left ventricular myocardium and ejection fraction.

When conducting an immunological blood test, there is an increase in immunoglobulins (IgM and IgG), an increase in viral antibody titers. The most accurate diagnostic information can be obtained from endomyocardial biopsy of the heart muscle.

Treatment of non-rheumatic carditis in children

Therapy for non-rheumatic carditis in children includes inpatient and rehabilitation outpatient treatment. During the period of hospitalization, the child's motor activity is limited - bed rest is observed for 2-4 weeks. The basis of nutrition is a diet with a high content of potassium salts and vitamins. The child is shown exercise therapy under the supervision of an instructor.

Drug therapy for non-rheumatic carditis in children consists of NSAIDs, glucocorticosteroids, cardiac glycosides, diuretics, metabolic drugs, antiplatelet agents, anticoagulants, antiarrhythmic drugs, ACE inhibitors, etc. If the etiological factor of non-rheumatic carditis is known, the child is prescribed appropriate etiotropic treatment (immunoglobulins, interferons, antibiotics ).

At the outpatient stage, rehabilitation measures are shown in the conditions of a cardio-rheumatological sanatorium. Dispensary observation of children who have had acute and subacute non-rheumatic carditis is carried out for 2-3 years; congenital and chronic variants require lifelong follow-up. Preventive vaccinations for children who have had non-rheumatic carditis are carried out after deregistration; chronic carditis is a contraindication to vaccination.

Forecast and prevention of non-rheumatic carditis in children

With a favorable development of events, the symptoms of heart failure gradually regress, the size of the heart decreases, and the heart rhythm normalizes. Mild forms of non-rheumatic carditis in children usually end in recovery; in severe cases, mortality reaches 80%. Factors that aggravate the prognosis are progressive heart failure, cardiosclerosis, pulmonary hypertension, persistent arrhythmias and conduction disturbances.

Prevention of congenital non-rheumatic carditis in children is to prevent intrauterine infection of the fetus. Hardening of the child, treatment of focal infections, prevention of post-vaccination complications allows to exclude the development of acquired carditis.

Carditis (inflammation of the membranes of the heart): non-rheumatic and rheumatic, signs, treatment

Carditis is an infectious-allergic inflammation of the various membranes of the heart. Carditis occurs in almost all age groups, but most often in young children, mainly in boys. The disease is manifested by nonspecific symptoms and dangerous development of complications. Carditis is characterized by tachycardia, shortness of breath, cyanosis. Sick children lag behind in physical development from their peers.

In practical medicine, the term "carditis" means the simultaneous defeat of several membranes of the heart at once.

Classification

According to the time of occurrence, carditis is classified into congenital and acquired.

• Congenital carditis is detected in newborns almost immediately after birth. The disease is caused by an intrauterine infection that the pregnant mother suffered.
• Acquired carditis is a complication of acute infectious diseases.

Downstream, carditis can be acute, subacute, chronic, recurrent.

1. Acute inflammatory process lasts 3 months,
2. Subacute - up to 18 months,
3. Chronic - up to 2 years.

By etiology: infectious, allergic, idiopathic, rheumatic.

localization of carditis (from left to right): inner shell of the heart - endocardium (endocarditis), cardiac muscle - myocardium (myocarditis), outer shell of the heart - pericardium (pericarditis)

Etiology

The causes of carditis are very diverse. The main etiological factor of the disease is infection.

Other causes of the disease include allergies to certain drugs, serums and vaccines, as well as to chemical and physical factors.

In a separate nosology, rheumatic carditis is distinguished, which is characterized by the involvement of all membranes of the heart in the pathological process. The cause of inflammation of the membranes of the heart can be any diffuse disease of the connective tissue.

Factors contributing to the development of the disease:

1. hypothermia,
2. increased susceptibility to toxins and allergens,
3. decrease in immunological resistance,
4. intoxication,
5. stress,
6. physical stress,
7. surgical manipulations on the heart,
8. burdened heredity,
9. radiation,
10. the impact of physical agents.

Pathogenesis and pathomorphology

layers of the heart wall affected by carditis

Microbes with blood flow penetrate into the heart muscle from the foci of chronic infection in the body. In muscle cells - myocytes, the process of replication occurs. Bacteria have a direct cardiotoxic effect, which leads to the development of inflammation and the formation of foci of destruction in the membranes of the heart. Microcirculation and vascular permeability are disturbed in them, myofibrils are destroyed, thrombosis, embolism, and hypoxemia occur.

Microbes are antigens to which antibodies are produced in the blood serum. A protective reaction develops, the function of which is to limit the pathological process. Viruses are blocked and eliminated. Increases the synthesis of collagen in the affected structures of the heart, which replaces the inflamed tissue. It gradually thickens, which ends with the formation of scar fibrous tissue.

With viral carditis, microbes persist in cardiomyocytes. Unfavorable environmental factors activate them, an exacerbation of the disease occurs. The pathogenic effect of viruses and their toxins causes damage to the myocardium, the development of alternative and dystrophic-necrotic inflammation. Metabolism is disturbed in the muscle, cell destruction occurs under the influence of lysosomal enzymes, microcirculation and blood coagulation are disturbed. Cardiomyocytes are destroyed and become the object of autoaggression. Antibodies to cardiomyocytes appear in the blood, immune complexes are formed that settle on the walls of blood vessels and affect them. Infiltrates are formed on the vascular endothelium, proliferation develops. Patients have cardiomegaly, thickening of the pericardial layers.

Symptoms

Clinical signs of carditis are nonspecific. They depend on the form of pathology, etiology and the state of the macroorganism.

• The disease of viral etiology is manifested by the classic symptoms of intoxication and asthenization of the body: weakness, hyperhidrosis, dyspeptic and encephalitic reactions, stabbing or pressing pain in the heart. During percussion, auscultation and additional diagnostic methods, cardiomegaly, hypotension, systolic murmur, a kind of "gallop rhythm" are detected.
• Bacteriological carditis is quite difficult to recognize. Characterized by fever, heart pain, shortness of breath, wheezing. In patients, the body temperature rises to subfebrile or febrile values, the pulse becomes frequent and arrhythmic. Acute bacterial carditis is accompanied by subcutaneous hemorrhages, expansion of the boundaries of the heart, and a decrease in blood pressure.
• Non-infectious forms of carditis are manifested by approximately the same symptoms of varying severity. The clinic of rheumatic heart disease is determined by the spread of inflammation to the membranes of the heart. Usually patients complain of shortness of breath, palpitations during movement, chest pain. During the examination, they reveal tachycardia, moderate hypotension, systolic murmur at the apex of the heart, and an abnormal gallop rhythm. Then there are symptoms of congestive heart failure, heart rhythm disturbance. In the case of rheumatic pericarditis, the valvular apparatus of the heart is affected.
• Congenital carditis appears immediately after birth. Sick children are underweight, get tired quickly when feeding, they are very restless and pale. During the examination, children are found to have cardiomegaly, muffled heart sounds, hepatomegaly, wheezing in the lungs, swelling of tissues, myalgia, orchitis, rashes on the skin and mucous membranes. Early intrauterine carditis is characterized by the growth of fibrous tissue in the myocardium without obvious inflammatory signs. Possible development of heart defects. Late carditis presents with classic signs of inflammation without proliferation of connective tissue.

The acute form of the disease ends with recovery or transition to a subacute form. In patients, the symptoms of intoxication increase again, but they are less pronounced, signs of dystrophy and heart failure appear. Subacute carditis often takes a protracted course. The chronic form of the pathology is asymptomatic for a long time. The patients feel well. As the pathology progresses, signs of heart failure, hepatomegaly, leg edema, and extracardiac manifestations appear.

Chronic carditis often takes a protracted course, against which various complications develop.

Diagnostics

To correctly diagnose carditis, it is necessary to collect an anamnesis and find out complaints. The results of instrumental and laboratory studies will help confirm or refute the alleged diagnosis.

1. In the blood of patients, pronounced leukocytosis, an increase in ESR, dysproteinemia.
2. Microbiological examination of the discharge of the nasopharynx allows you to isolate the causative agent of the disease. In the blood - antibacterial, antiviral and anticardiac antibodies.
3. These immunograms indicate characteristic changes in the immune status - an increase in IgM and IgG immunoglobulins, an increase in antibody titers.
4. If rheumatic heart disease is suspected, patients are advised to donate blood for rheumatoid factor.
5. Electrocardiography is an important instrumental method that detects myocardial damage in carditis and reveals arrhythmia, AV blockade, hypertrophy of the left heart chambers.
6. PCG - systolic murmur, the appearance of pathological 3rd and 4th tones.
7. X-ray of the chest organs - cardiomegaly, an increase in the thymus gland in children, congestion in the lungs.
8. Angiocardiography is a study of the cavities of the heart and coronary vessels by introducing a contrast agent. The resulting image shows the coronary arteries and chambers of the heart. This technique allows you to assess the shape and size of the left ventricle, the condition of the interventricular septum, the presence of blood clots in the heart.
9. Ultrasound of the heart - expansion of the chambers of the heart, accumulation of exudate in the pericardial cavity.

Treatment

Treatment of carditis is complex and staged. Specialists prescribe drugs to patients that destroy microbes, reduce inflammatory signs, stimulate immunity, and restore metabolism in the myocardium. The choice of therapeutic methods is determined by the etiology of the disease, the state of the patient's immune system, the nature of the course and the degree of cardiovascular insufficiency.

The main stages of treatment of carditis:

Acute infectious carditis is treated in a hospital. Patients are shown bed rest with limited motor activity. Diet therapy consists in the use of foods with a high content of minerals and vitamins. A complete and fortified diet is recommended with a restriction in the diet of salt and liquid. Useful products: dried apricots, nuts, raisins, figs, baked potatoes, prunes.

Rehabilitation of adults and children is carried out in a cardio-rheumatological sanatorium. Babies who have had carditis are registered with a pediatric cardiologist for 2-3 years.

Medical therapy

Conservative treatment of carditis is to use the following groups of drugs:

1. NSAIDs - "Indomethacin", "Diclofenac", "Ibuprofen",
2. Glucocorticoids - "Prednisolone", "Dexamethasone",
3. Cardiac glycosides - "Strophanthin", "Korglikon",
4. Diuretics - "Hypothiazid", "Veroshpiron",
5. Cardioprotectors - Panangin, Riboxin, Trimetazidine,
6. Antiplatelet drugs - "Acetylsalicylic acid", "Cardiomagnyl",
7. Anticoagulant drugs - "Heparin", "Kurantil",
8. Antiarrhythmic drugs - "Quinidine", "Novocainamide",
9. ACE inhibitors - Captopril, Enalapril,
10. Immunomodulators - "Anaferon", "Viferon", "Kipferon",
11. multivitamins,
12. Antihistamines - "Tavegil", "Suprastin", "Zirtek",
13. Antibiotics from the group of cephalosporins, fluoroquinolones, macrolides.

In a severe form of the disease, oxygen therapy, blood transfusions, intravenous administration of vitamins of groups C, B, K are indicated.

Outpatient treatment of carditis consists in the use of drugs that stimulate the metabolism in the myocardium - Panangin, Riboxin, Mildronate, maintenance doses of cardiac glycosides, antiarrhythmic, diuretic and sedatives.

Carditis is successfully treated with traditional means of modern medicine. Anti-inflammatory and cardiac therapies can improve the condition of patients and eliminate the symptoms of the disease. But despite this, the risk of complications remains relevant in all age groups. Only timely access to specialists and competent treatment of patients will help to avoid the development of chronic diseases of the cardiovascular system.

Non-rheumatic carditis in a child: signs and features of treatment of newborns

The term "non-rheumatic carditis" combines a group of inflammatory diseases of the heart membranes, not associated with rheumatism and other systemic pathologies, often of an infectious or allergic nature. Depending on the localization of the lesions, myocarditis, endocarditis, pericarditis are isolated, and with inflammation of two or more membranes - myopericarditis, pancarditis. The clinical picture depends on the age of the child, the most characteristic signs are heart rhythm disturbances, shortness of breath, anemia, stunting or physical development.

What is the basis for the development of the disease

The disease can be caused by various factors of an allergic or infectious nature. Infectious agents can affect the heart muscle in patients of any age, and also cause congenital heart pathologies. Among the pathogenic microflora that causes cardiac manifestations, there are:

• Viruses (adenoviruses, influenza virus, ECHO, Coxsackie).
• Bacteria (streptococci, staphylococci).
• Mushrooms.

With allergic etiology, the pathology develops against the background of hypersensitivity of the body after the introduction of vaccines, sera, and medication. A mixed form is also observed, when both viruses or bacteria, and allergic reactions become the cause.

Characterization and manifestation

The disease is classified depending on the cause of occurrence, as well as the time for which the first clinical signs occur.

The course of the congenital form

Congenital non-rheumatic carditis may appear in the first days or months of life, or be asymptomatic for several years. Depending on this factor, early or late congenital carditis should be distinguished.

Early non-rheumatic carditis is diagnosed in newborns immediately after birth or within the first 6 months. In such patients, pallor of the skin, visible mucous membranes, underweight, they lag behind their peers in growth or physical development. Tachycardia (increased heart rate) can be observed even at complete rest, it increases with little physical activity (when feeding, bathing). Clinical signs are also cardiomegaly (enlargement of the heart muscle), heart failure, heart hump, swelling.

Late carditis in children appears at the age of 2-3 years. The main symptoms that accompany this course of the disease are heart rhythm disturbances (tachycardia) and conduction disturbances (atrioventricular blockade). Signs of heart failure are present, but to a lesser extent than in newborns. If convulsions are observed along with impaired cardiac function, there is reason to diagnose an infectious lesion of the central nervous system.

Congenital non-rheumatic carditis in children should be distinguished from heart defects and other congenital pathologies. With the timely start of treatment, the prognosis is favorable: in children who have had the disease, the work of the heart normalizes over time. With concomitant diseases or a severe form, there is a risk of death.

Don't delay going to the doctor, it can aggravate the situation!

The course of the acquired form

Acquired carditis occurs in patients of preschool or school age. Depending on the course, acute, subacute and chronic forms are distinguished.

The acute form develops after an infectious pathology suffered by the child. The first symptoms are shortness of breath, shortness of breath, pallor or cyanosis (cyanosis) of visible mucous membranes. The general picture is accompanied by cough, dyspepsia, nervous disorders. ECG reveals rhythm and conduction disturbances of varying severity.

The subacute course is typical for schoolchildren, it is manifested by rapid fatigue, there are also signs of heart failure. With chronicity, the process proceeds without obvious symptoms of inflammation of the heart muscle. Chronic course correspond to cough, shortness of breath, nausea, pain in the abdominal cavity, growth retardation. The disease should be distinguished from diseases of the respiratory and digestive systems.

Pathology develops after an infectious disease or as a result of allergic reactions. The acute form can end in complete recovery or become chronic.

The final diagnosis is made by a cardiologist on the basis of anamnesis data and additional research methods (electrocardiography, ultrasound, X-ray). Patients who have had infectious diseases have to be especially careful, as they are at risk. The doctor collects this data during the first examination. There are difficulties in diagnosing the chronic form, since the disease can be asymptomatic for a long time, while the patient carries out full physical activity.

It is necessary to do all the tests to make sure that there is no disease

When conducting an ECG, rhythm and conduction disturbances (tachycardia, bradycardia, various blockades) are detected. X-rays will show an increase in the heart in volume, a change in its shape, an increase in the lungs due to venous congestion, and the appearance of edema. Ultrasound examination will determine the expansion of the cavities of the heart and other visible pathologies.

With non-rheumatic carditis, therapy takes place in a hospital, under the supervision of a cardiologist. The child is prescribed bed rest, a diet with a high content of calcium. The restoration of the patient's motor activity occurs gradually, physiotherapy exercises are prescribed.

Drug therapy is selected individually, taking into account the age of the patient and the form of the course of the disease. For treatment, drugs of the following groups are prescribed:

• Non-steroidal anti-inflammatory drugs.
• In severe cases - glucocorticoids.
• In heart failure - cardiac glycosides, vasodilators, diuretics.
• In chronic course - aminoquinoline derivatives.

With established etiology, treatment of the underlying disease is necessary. Assign a course of antiviral, antibacterial, fungicidal (antifungal) drugs aimed at eliminating infectious microflora.

To prevent the congenital form of the disease, the possibility of infection of the fetus during pregnancy should be avoided. At a younger age, it is worth strengthening the immune system to fight possible infectious diseases. Secondary prevention is to prevent complications and relapses.

Non-rheumatic carditis in childhood is dangerous and can lead to undesirable consequences. When the first symptoms appear, you should urgently consult with a cardiologist, conduct all the necessary studies. The course of treatment is selected individually. In addition to specific medications, a diet and physical activity are prescribed, and periodic monitoring of the patient is carried out. Compliance with all doctor's recommendations is mandatory.