Myocarditis: symptoms, treatment, causes,diagnosis, prognosis

Update: December 2018

Diseases of the heart and blood vessels are the leading cause
mortality in all developed countries – up to 31% of all deaths
according to WHO. One of the diseases that contribute to this
mortality is myocarditis.

Myocarditis is a serious disease of the heart muscle,
characterized by inflammation of the middle, thickest, layer
heart – myocardium. Leading role in the occurrence of this pathology
belongs to infections, less often – allergic and autoimmune
diseases. In rare cases, myocarditis occurs as a consequence.
poisoning with toxic substances. Myocarditis accounts for up to 10%
heart disease.

Classification of myocarditis, depending on its causes

The basis of the international classification of this disease lies
etiological factor, that is, the main reason that causes
disease. Based on this, the following forms are distinguished.
myocarditis.

Infectious

Severe infectious disease, especially in people with
weakened by immunity, often gives a complication of the heart –
develops inflammation of the heart muscle. As the root cause
can act:

  • viruses of herpes, flu, hepatitis, Coxsackie virus;
  • bacteria: diphtheria bacillus, streptococcus, rickettsia,
    chlamydia;
  • fungi of the genus Candida and Aspergillus;
  • parasites, including helminths: echinococcus, roundworm, bovine
    tapeworm.

Rheumatic

Essentially, rheumatic myocarditis is a type of
infectious, but due to its prevalence and characteristics
highlighted in a separate form. The reason is a pronounced immune response to
Streptococcus haemolyticus (hemolytic streptococcus).

Allergic

The leading process in the formation of this form of the disease is
allergic reaction, and the trigger factors can be
different states:

  • burn disease – massive tissue necrosis leads to release into
    the blood of the destroyed proteins and toxins that cause the synthesis of autoimmune
    antibodies that affect the myocardium;
  • post-transplant condition – an immune response to
    graft leads to heart damage;
  • drug allergy – some drugs increase affinity
    antibodies to the heart, causing the antibodies to cause inflammation in
    myocardium.

This type of myocarditis also includes idiopathic, the reason
which is not fully understood.

Toxic

Alcohol intoxication, uremia (increased blood levels
uric acid due to renal failure) poisoning
some heavy metals can trigger myocarditis.

Symptomatic

Quite often, myocarditis develops on the background of chronic
diseases, as a rule, autoimmune: systemic lupus erythematosus,
scleroderma.

How does myocarditis develop

Regardless of the form of the disease at the heart of its development lies
impaired immune responses. The defeat of some parts of the immune
systems leads to the fact that autoantibodies begin to be synthesized to
myocardium. The peculiarity of these antibodies is that they
unite with myocardial cells and trigger inflammatory
the reaction.

Of course, this is a very simplified scheme for the development of the disease – in
The formation of clinical symptoms involves not only antibodies, but
and immune cells, as well as regulatory compounds – mediators
inflammation.

Symptoms of myocarditis

This disease is characterized by symptoms of impaired cardiac
functions. The severity of violations depends on the degree of damage
myocardium. On this basis, focal emit when inflammation
affects certain areas of the heart muscle, and diffuse –
whole heart is affected – myocarditis.

The severity of symptoms depends on the extent of the lesion, and
diffuse form of myocarditis is much more severe. Heaviness
currents also determine the severity of heart damage, localization
foci of inflammation and rate of progression
heart failure

Patients most often present the following complaints:

  • fast fatiguability;
  • chest pains (“heart ache”);
  • shortness of breath even with little exertion;
  • excessive sweating;
  • palpitations or a feeling of heart failure.

Myocarditis classification by leading clinical symptom

Title Symptoms
Malosymptomatic minor weakness, fatigue, heart
the symptoms are almost absent. In this case, most often
infectious-allergic myocarditis.
Pain or pseudo coronary The appearance of pain in the heart. Pains can wear
different character: stabbing, pressing, burning – clinical picture
resembles ischemic heart disease. Pain more often occurs when
idiopathic or rheumatic myocarditis.
Decompensatory (with circulatory disorders) There are signs of impaired peripheral circulation –
swelling appears, the skin of the limbs can become bluish
colors. Heart failure most often develops with
diffuse myocarditis.
Arrhythmic Heart rhythm disturbance is characteristic – this is either bradycardia.
(decrease in heart rate) or arrhythmia.
Thromboembolic With this form, a high probability of thrombus formation is
pulmonary artery (PE), so in the vessels of the great circle
blood circulation – in the legs and internal organs. This option
It is noted in rickettsial and bacterial myocarditis.
Pseudo-valve Due to changes in the myocardium, valve deformation occurs
heart, which is manifested by the appearance of noise in the heart. With auscultation
Hearts most often during myocarditis are heard the noise at the top
hearts.
Mixed To a varying degree, any of the listed
symptoms.

What does a patient with myocarditis look like

The appearance of a patient with myocarditis is determined by the severity
diseases:

  • With a mild course of the disease and at the initial stage the patient
    indistinguishable from a healthy person – he is concerned only with the general
    weakness.
  • As it progresses, with moderate flow and in
    neglected cases, the patient acquires a typical appearance:
    pale skin, lips, fingers and toes (sometimes
    brushes with feet) have a bluish tint.
  • With a decompensated form, the swelling of the cervical
    veins, especially during physical exertion. When walking is celebrated
    severe dyspnea that makes a person periodically
    stop to rest. For decompensated
    myocarditis is characterized by the appearance of edema of the legs. When any
    mentioned symptoms should consult a doctor.

The first signs of myocarditis most often (in 80% of cases) appear
3-8 weeks after any infectious disease. it
may be flu, cold, sore throat. Tell your doctor if you recently
were sick!

Diagnosis of myocarditis

Making a correct diagnosis is significantly difficult due to
lack of specific symptoms – myocarditis can
�”Disguise” under another heart pathology. So the stages
diagnosis of myocarditis:

History taking

The doctor talks with the patient, figuring out the complaints, the circumstances of their
appearances, the nature of complaints change over time. Special attention
given diseases, especially viral and
bacterial infections.

Study the current status of the patient (Status praesens).
Consists of several points:

  • Examination of the patient, aimed at identifying signs of heart
    insufficiency: shortness of breath, edema of the legs, cyanosis of the skin
    integuments, swelling of the neck veins.
  • Auscultation. The doctor listens to the heart and lungs. With myocarditis
    there is a muffled heart tone, a stranger may appear
    heart murmur. The lungs often have weakened breathing.
    за счет застоя крови из-за ослабления работы hearts.
  • Percussion. With the help of “tapping” the doctor determines the boundaries
    сердца – при этом заболеваний типично расширение hearts.
    The relevance of this procedure has decreased slightly due to the appearance
    ultrasound methods of research, but an experienced doctor is always
    проводит перкуссию hearts.

Laboratory and instrumental examination

it самый важный этап, так как только совокупность результатов
Multiple research methods will allow with a high probability
reveal myocarditis.

What tests and studies prescribed for myocarditis

Title исследования или анализа The result of the survey Clarification
ECG – a study of the electrical activity of the heart On the electrocardiogram of changes it is not revealed ATариант нормы или начальная стадия myocarditis.
Focal conduction and excitability, decrease
voltage of some teeth on the ECG.

They speak in favor of myocarditis, but are not typical
by signs. It is recommended to conduct an ECG at intervals of several
days – myocarditis is characterized by inconstancy of changes in
ECG.

Нельзя поставить диагноз миокардита только по ECG.

BP measurement Persistent hypotension – a decrease in blood pressure. This phenomenon is due to myocardial damage, as a result
which the heart cannot maintain normal pressure in
vessels.
Doppler ultrasound of the heart (allows you to determine the state
myocardium). Of great importance is the study of its contractile
functions.
  • Myocardial hypertrophy (thickening), heart enlargement,
    expansion of the heart cavities.
  • Reduced ejection fraction.
  • Миокард утолщается преимущественно за счет inflammation.
    The relative increase in the cavities of the heart indicates the development
    heart failure.
  • Inflamed myocardium is not able to contract normally. By
    which reduces the amount ejected in one reduction
    blood.
  • The degree of change depends on the severity of the disease.
 Radiography of the chest (heart and
lungs)
 No changes detected  Lack of myocarditis, or focal form.
  • Расширение границ hearts.
  • Congestion in the lungs.
 A sign of moderate or severe severity. Stagnant
явления характерны для декомпенсации сердечной functions.
MRI of the heart Thickening of the heart wall, expansion of the heart cavities and
pulmonary vessels (due to pulmonary hypertension)
MRI is one of the most informative diagnostic methods.
myocarditis. Using this study, you can estimate the value
inflammatory myocardial edema, identify foci of inflammation in
diffuse form.
Scintigraphy Labeled radioisotopes actively accumulate in inflammatory
foci.
The accuracy method is only marginally inferior to MRI. Allows
diagnose the disease at an early stage.
General blood analysis Leukocytosis (increase in the total number of leukocytes) Not a specific analysis. Testifies only about
the presence of inflammation in the body, including infectious
character
Blood tests: biochemical, serological. Increased markers of inflammation, antibodies, increased C-reactive
protein, aminotransferase.
it неспецифичные анализы. Allowing only confirm again
presence of inflammation.
Immunological analysis Increasing the concentration of cardiotropic antibodies. The analysis allows you to establish an allergic nature
myocarditis.

For the diagnosis of this disease are involved different
specialists: cardiologists, rheumatologists, functional doctors
diagnostics, radiologists. Most often, the diagnosis is set to
Consilium joint efforts of several doctors.

What is dangerous myocarditis

Heart failure in myocarditis is fraught with dangerous manifestations,
some of which can cause death.
The inflammatory process in the myocardium further leads to the replacement
myocardiocytes (muscle fibers) connective tissue. AT
As a result, the heart can no longer adequately deal with
its function is to pump blood. it приводит к
формированию тяжелой heart failure.

ATоспалительный процесс препятствует нормальному проведению
electrical impulses in the heart, leading to cardiac arrhythmias. AT
особо тяжелых случаях возможна остановка hearts.

How to treat myocarditis

AT острый период заболевания пациент подлежит обязательной
hospitalization, regardless of whether
there was a disease or this next aggravation, as with
rheumatic myocarditis. From the patient first required
restriction of physical activity – prescribed bed rest.
These activities are aimed at reducing the load on the heart and
cardiac compensation.

ATажный компонент лечения – диета, назначается стол №10 по
Pevzner, which is useful in most heart conditions,
features of such power:

  • limiting the amount of fluid consumed
  • reduced amount of salt
  • the consumption of baked goods, fried
    products, meat, smoked meats.

Лечение миокардита направлено на все звенья diseases: на
elimination of the pathogen, removal of inflammation (pathogenetic
therapy), elimination of symptoms (symptomatic treatment).

Etiological treatment

Antibiotics, antiviral drugs,
antiprotozoal drugs is carried out if you suspect the presence of
in the body of the corresponding pathogen. At the same time necessarily
all foci of chronic infection in the body are sanitized: abscesses,
carious teeth, sinusitis, adnexitis, prostatitis and so on.

When prescribing an antibiotic, it is desirable to determine
pathogen sensitivity to it, although at first these drugs
prescribed empirically – use a wide range of antibiotics
spectrum of action.

When autoimmune or allergic myocarditis is used
hormonal drugs.

Pathogenetic treatment

To eliminate inflammation in the myocardium, you can use:

  • glucocorticosteroids – hormones (prednisone, metipred, etc.)
    prescribed for severe disease, as well as for autoimmune
    lesion because these drugs are immunosuppressive
    action. Anti-inflammatory effect is realized by
    suppression of antibody synthesis.
  • нестероидные противовоспалительные средства (НПATС) применяют
    with light and moderate flow. Myocardial edema is eliminated, with
    pain form is significantly reduced or completely disappears
    pain syndrome. The frequency of taking the drugs is determined by the doctor, with
    taking into account the individual characteristics of the disease. Examples
    препаратов: Ибупрофен, ATольтарен, Диклофенак, Ибусан, Нурофен (см.
    pain medication).
  • antihistamine drugs – see list of pills from
    allergies

Продолжительность терапии НПATС и гормонами определяется
the result of repeated analyzes: in biochemical and general analyzes
исчезают признаки inflammation.

Symptomatic treatment

To eliminate the external manifestations of the disease is prescribed the following
drugs:

  • antiarrhythmic – with pronounced arrhythmias;
  • anticoagulants – for the prevention of thrombosis (with
    thromboembolic variant), aspirin, thrombotic ass (see list
    anticoagulants of direct and indirect action).
  • pressure boosting agents – at very low pressure.

Metabolic therapy of myocarditis

ATо время лечения следует поддержать миокард, поэтому врачи
prescribe drugs that stimulate the metabolism in the heart and
improving its nutrition. The task of these drugs is to facilitate
cardiac muscle recovery. These drugs include
vitamins, ATP, riboxin, mexicor.

Potassium preparations also contribute to the recovery of myocardium,
improve intracardiac conduction, hinder the development
arrhythmias.

The duration of myocardial treatment in the best case
is 4 months, but after the course is recommended
rehabilitation. AT среднем же лечат миокард 6-7 месяцев, а в тяжелых
cases – up to a year.

Forecast

When olymptosis option possible complete cure without
any complications and consequences. AT тяжелых случаях у пациентов
chronic heart failure develops. With some
variants of the course the risk of death is very high:

  • in Chagas disease, symptomatic myocarditis leads to death
    in 30-40% of cases
  • with diphtheria mortality is 50-55%.

In rheumatic and idiopathic myocarditis is noted
tendency to relapse – depending on the severity of relapses may
occur every year or less. AT этом случае проводится
anti-relapse treatment.

Prevention of myocarditis

Prevent the disease by adhering to non-specific
methods of prevention:

  • hardening;
  • healthy, balanced diet;
  • refusal of bad habits that reduce immunity
    (alcohol, smoking, drugs);
  • improving living conditions;
  • timely treatment of infectious diseases;
  • прием витаминов в период эпидемий гриппа и ОРATИ;
  • vaccination against the most common infections: diphtheria,
    rubella, measles, herpes and others.

With a recurrent course, follow-up is necessary.
cardiologist: consultation is required every 3 months in the first year
after illness and every six months in the next 3 years.

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