Myocarditis. Causes, symptoms and signs, diagnosis and treatment of the disease

Myocarditis- This inflammatory lesions myocardium arising in connection with an infectious or allergic disease.

Etiology

Cause of the majority non-rheumatic myocarditis is a tonsillogenic (streptococcal) or respiratory (viral) infection. Often, myocarditis complicates pneumonia, cholangitis, tuberculosis, sepsis, etc. It has now been proven that any infection can be complicated by myocarditis, but it should be borne in mind that, in addition to infection, myocarditis can also be caused by allergic and physical factors. Non-rheumatic myocarditis is quite common.

Pathogenesis

In the pathogenesis of myocarditis, an important role is played by myocardial damage caused by direct invasion of the pathogen (bacteria, viruses, fungi, rickettsia, protozoa) or its toxins, as well as allergic mechanisms damage associated with invasion or prior myocardial sensitization. In pathogenesis, the most severe forms myocarditis important belongs to autoimmune reactions of both delayed and immediate type.

Pathomorphology

Depending on the features morphological changes myocarditis is distinguished by: localization pathological process- parenchymal and interstitial; character inflammatory response- alternative, exudative or productive; specificity - specific or non-specific; prevalence - focal or diffuse. The severity of morphological changes varies over a very wide range: from mild nested lesions, difficult to establish histologically, to the most severe - total.

Classification

The international classification of myocarditis is compiled exclusively according to the etiological principle (rheumatic, streptococcal, viral - indicating the type of virus, etc., see table).

Clinic and diagnostics

The clinical picture of non-rheumatic myocarditis is extremely variable and depends on the depth, extent and severity of myocardial damage. On the one hand, there are very mild, asymptomatic forms, when the diagnosis is made only on the basis of an electrocardiographic study; on the other hand, there are severe, uncontrollably progressive and ending lethal outcome. The disease usually begins either during the period of convalescence, or (more often) 1-2 (rarely more) weeks after recovery from a particular infection.

One of the most common signs of the onset of the disease is pain. Pain often becomes angina pectoris, which is the reason for the misdiagnosis of angina pectoris or myocardial infarction. In addition, there are stabbing or aching pain in the region of the heart without irradiation, often becoming permanent. Pain accompanied by palpitations or interruptions heart rate, weakness and fatigue appear, shortness of breath during physical exertion.

Of the objective signs of the disease are noted: subfebrile temperature body (optional sign): tachycardia (less often - bradycardia); decline blood pressure. The boundaries of the heart are often dilated (usually moderately), a systolic (muscle) murmur is heard above the apex. The tones are deaf, I tone is often split.

Enough frequent sign- embryocardia. The liver is not enlarged, its moderate increase is occasionally noted. There are no edema in most cases. A blood test may (but not necessarily) detect moderate neutrophilic leukocytosis, eosinophilia, and a moderate increase in ESR. Approximately one third of patients have a positive reaction to C-reactive protein.

With great constancy, changes in the final part of the ECG are detected ( S-T offset; changes T-flat, biphasic, negative: widening of the QRST complex).

First option infectious myocarditis- pain - usually not accompanied by heart failure and ends after 1-2 months. recovery. However, in some cases, pain and adynamia do not go away for a long time, and therefore the treatment is delayed up to 3-6 months.

The second variant - arrhythmic - infectious myocarditis is characterized by a violation of the heart rhythm and conduction. In the convalescence phase or 1-2 weeks after the end infectious process revealed (electrocardiographically and clinically) violations of atrioventricular conduction up to complete blockade in severe cases), blockade of the legs of the bundle of His (often of the Wilson type), a transient or permanent form of atrial fibrillation, paroxysmal tachycardia, WPW syndrome, etc.

It should be noted that atrioventricular conduction disorders are relatively less common than with rheumatic myocarditis. Circulatory disorders may initially be absent. They appear later, with the long-term existence of such severe types of rhythm disturbances as poppy atrioventricular blockade, atrial fibrillation, paroxysmal tachycardia. The prognosis for this option is usually less favorable, because. we are talking more severe and severe myocardial damage.

The third variant of infectious myocarditis is characterized by the appearance of symptoms of circulatory failure from the very beginning. These are cases with severe diffuse myocardial damage, often in combination with rhythm and conduction disorders.

Circulatory failure often develops according to the right ventricular type or is total (with stagnation in the systemic and pulmonary circulation). The examination reveals tachycardia, hypotension, expansion of the boundaries of the heart in diameter, muffled tones, systolic murmur above the top.

Often there is a gallop rhythm, alternating pulse, embryocardia. On the ECG, a low-voltage curve, a downward shift of S-T, negative T, widening of the QRS and QRS-T are recorded. The prognosis is mostly unfavorable. In the case when myocardial damage develops in the course of a particular infection, phenomena vascular insufficiency up to severe collapse.

G. F. Lang pointed out this feature of hemodynamic disorders in patients with myocarditis.

The clinical manifestations of the mixed variant largely depend on the combination of leading syndromes. The following combinations are more common: pain syndrome with rhythm disturbance; rhythm disturbance with circulatory failure. The prognosis is usually serious.

Finally, such variants of myocarditis are known, when it is clinically impossible to establish any pathological changes from the side of the heart, and the diagnosis is based solely on electrocardiographic data. Usually these are mild, favorable cases of myocarditis; however, it also happens sudden death from latent myocarditis.

The most severe course and prognosis is Abramov-Fiedler type myocarditis. There is reason to consider it as a polyetiological disease with an autoimmune genesis. However, the details of the pathogenesis of this most severe form of myocarditis have not been disclosed, and the problem of treatment cannot be considered solved.

In practical work, the following diagnostic criteria for infectious myocarditis should be taken into account:

I. Main: 1) connection with infection (epidamnesis, clinical and laboratory data); 2) signs of isolated (without the participation of endo- and pericardium) myocardial damage - subjective (pain in the region of the heart, palpitations), physical (tachycardia, shortness of breath, weakening of the first tone and muscle systolic murmur, an increase in heart size, hypotension, circulatory failure); instrumental (ECG changes in the T wave, increased electrical systole, rhythm and conduction disturbances).

II. Additional: 1) common manifestations- fever, weakness, weakness, fatigue; 2) laboratory parameters: the appearance of C-reactive protein, an increase in ESR, leukocytosis.

Differential Diagnosis

In the process of making a diagnosis of infectious myocarditis, certain difficulties are possible. At the same time, there is often a need for differential diagnosis With functional diseases of cardio-vascular system, ischemic disease heart, thyrotoxicosis and rheumatic heart disease.

In differential diagnosis with neurocirculatory dystonia must be remembered that during various infections and in the convalescence phase, vasomotor balance is often disturbed, phenomena develop vascular dystonia. Infectious myocarditis occurs, as a rule, against the background of dystonia, the symptoms of which do not exclude signs of myocardial damage.

It is important to consider the following main features that distinguish NCD from myocarditis: 1) numerous complaints of irritability, bad dream, headaches, dizziness; 2) the absence of objective changes in the heart; 3) lability of blood pressure and pulse; 4) lack of ECG signs myocardial damage; 5) the presence of signs of neurasthenia in many patients; b) normal performance blood.

In the presence of painful forms myocarditis, differential diagnosis with coronary heart disease is necessary, and the assessment of pain syndrome is important. In patients with ischemic disease, a typical anginal syndrome prevails; in patients with myocarditis, aching and stabbing, prolonged, sometimes almost constant pain without irradiation.

Pain syndrome in myocarditis, even if it resembles an anginal attack, differs from the latter by the lack of effect from taking validol and nitroglycerin and does not have the stereotype characteristic of patients angina pectoris. In a number of patients with myocarditis, the pain syndrome is characterized by a long duration and persistence, resembling a picture of myocardial infarction, but differs from it in lesser intensity of pain and the exceptional rarity of cardiogenic shock.

In differential diagnosis with a fresh heart attack, it also helps that symptoms such as fever, leukocytosis, etc., which are symptoms of the second day in a heart attack, exist with myocarditis from the very beginning of the disease (if they are present at all).

Unlike myocardial infarction, which, as a rule, has typical ECG dynamics, with pain myocarditis, there is mostly a disproportion between the severity of the pain syndrome and the nature of the ECG changes: with a significant pain syndrome, moderate changes ECG; infarction-like curves in myocarditis are rare.

The need for differential diagnosis of myocarditis with thyrotoxic myocardial dystrophy arises primarily in cases where clinical picture diffuse toxic goiter dominated cardiovascular disorders, and the appearance of other symptoms characteristic of thyrotoxicosis is delayed. The correct assessment of the symptom of tachycardia helps to resolve the diagnostic problem.

It is important to highlight the resistance of tachycardia caused by thyrotoxicosis to anti-inflammatory and desensitizing therapy and, conversely, high sensitivity to antithyroid drugs. Function research thyroid gland confirms the diagnosis.

The greatest difficulties arise in the differential diagnosis with primary rheumatic heart disease. However primary rheumatic heart disease distinguish from infectious myocarditis lesser severity of complaints, greater constancy of symptoms such as fever, tachycardia, systolic murmur over the apex of the heart, a combination with polyarthritis. In addition, rheumatic heart disease is more typical of myocardial damage in combination with damage to the endo- and pericardium and a tendency to a recurrent course.

Complications in patients with myocarditis are most often manifested in the form of acute heart failure and various violations rhythm.

urgent health care in acute myocarditis is reduced to the fight against pain syndrome, rhythm and conduction disturbances, acute heart failure (see relevant sections). In the absence of contraindications, anti-inflammatory drugs may be prescribed ( acetylsalicylic acid, brufen, indomethacin, voltaren).

A patient with acute myocarditis is subject to urgent hospitalization V cardiology department hospital.

The prognosis of most infectious and infectious-allergic myocarditis is favorable. However, in 20% of cases, myocarditis ends with myocardial cardiosclerosis, a transition is possible acute myocarditis into chronic, relapsing.

Prevention

It involves the implementation of a set of measures aimed at preventing infectious myocarditis and its complications.

Primary prevention of infectious myocarditis consists of measures to prevent and treat infections, monitor the condition of cardio-vascular system not only at the height of the infection, but also in the convalescence phase. Persons who have undergone acute infection, it is advisable to release for 2-3 weeks from work associated with heavy physical exertion. Importance Sanitation of chronic foci of infection also has a preventive effect.

B.G. Apanasenko, A.N. Nagnibed

Inflammatory diseases of the myocardium various etiologies, not associated with group A β-hemolytic streptococcus, diseases connective tissue or others systemic diseases.

In pathogenesis are important:

• 1) direct introduction of the infectious factor into the myocardiocyte, its damage, the release of lysosomal enzymes (Coxsackie viruses, sepsis);
• 2) immunological mechanisms - reaction autoantigen - autoantibody, formation immune complexes, the release of mediators and the development of inflammation, the activation of lipid peroxidation.

Clinical laboratory and instrumental data

Light form

Complaints: general weakness, moderately expressed, pain in the region of the heart of a constant, stabbing or aching nature, interruptions in the region of the heart, palpitations are possible, slight shortness of breath with physical activity.

Objective examination: the general condition is satisfactory, there is no edema, cyanosis, shortness of breath. The pulse is normal or somewhat rapid, sometimes arrhythmic, blood pressure is normal, the boundaries of the heart are not changed, I tone is somewhat weakened, there is a soft systolic murmur at the apex of the heart.

Laboratory data. OAK is not changed, sometimes a slight increase in ESR. BAC: moderate increase in blood levels of AST, LDH, LDH1_2, CPK, α2- and γ-globulins, sialic acids, seromucoid, haptoglobin. Increased titers of antibodies to Coxsackie, influenza and other pathogens. A four-fold increase in antibody titers to pathogens during the first 3-4 weeks, high titers compared to the control, or a four-fold decrease subsequently are evidence of a cardiotropic infection. Taken into account stationary high level titers (1: 128), which is normally very rare.

ECG: a decrease in the T wave or ST segment in several leads, an increase in the duration of the P-Q interval are determined.

X-ray and echocardiographic examination of the pathology does not reveal.

Moderate form

Complaints of patients: severe weakness, pain in the region of the heart of a compressive nature, often stabbing, shortness of breath at rest and during exercise, palpitations and interruptions in the region of the heart, sub-febrile body temperature.

Objective examination. General state medium severity. Slight acrocyanosis, no edema and orthopnea, frequent pulse, satisfactory filling, often arrhythmic, normal blood pressure. The left border of the heart is enlarged to the left, the I tone is weakened, a systolic murmur of a muscular nature is heard, sometimes a pericardial rub (myopericarditis).

Laboratory data. OAK: increased ESR, leukocytosis, shift leukocyte formula to the left, with viral myocarditis, leukopenia is possible. BAC: increase in the content of sialic acids, seromucoid, haptoglobin, α2- and γ-globulins, LDH, LDH1_2, CPK, CPK-MB fraction, AsAT. IS: a positive inhibition of leukocyte migration in the presence of myocardial antigen, a decrease in the number of T-lymphocytes and T-suppressors, an increase in the blood levels of IgA and IgG; detection in the blood of the CEC, antimyocardial antibodies; V rare cases the appearance in the blood of the RF; detection of C-reactive protein in the blood, high titers of antibodies to Coxsackie, ECHO, influenza or other infectious agents.

ECG: a decrease in the interval S - T or a T wave in one or more often several leads, a negative, asymmetrical T wave may appear; possible monophasic ST elevation due to pericarditis or subepicardial myocardial damage; various degrees of atrioventricular blockade; extrasystole, atrial fibrillation or flutter, decreased ECG voltage.

X-ray of the heart and echocardioscopy reveal an increase in the heart and its cavities.

Severe form

Complaints: shortness of breath at rest and during exercise, palpitations, interruptions and pain in the heart, pain in the right hypochondrium, swelling in the legs, cough during exercise.

Objective examination. The general condition is severe, forced position, orthopnea, pronounced acrocyanosis, cold sweat, swollen neck veins, swelling in the legs. The pulse is frequent, weak filling, often thready, arrhythmic, blood pressure is reduced. The borders of the heart are enlarged more to the left, but often in all directions (due to concomitant pericarditis). Heart sounds are deaf, tachycardia, often gallop rhythm, extrasystole, often paroxysmal tachycardia, atrial fibrillation, systolic murmur at the apex, pericardial friction noise (with concomitant pericarditis) is determined by muscle origin. On auscultation of the lungs lower sections you can listen to congestive fine bubbling rales and crepitus as manifestations of left ventricular failure. In the most severe cases, there may be attacks of cardiac asthma and pulmonary edema. A significant increase in the liver is determined, its soreness, ascites may appear. With a significant increase in the heart, relative insufficiency of the tricuspid valve may develop, in the region of the xiphoid process, in this case, a systolic murmur is heard, which increases on inspiration (Rivero-Corvalho symptom). Quite often, thromboembolic complications develop (thromboembolism in the pulmonary, renal and cerebral arteries and etc.).

Laboratory data, including immunological parameters, undergo significant changes, the nature of which is similar to those in moderate myocarditis, but the degree of change is more pronounced. With significant decompensation and an increase in the liver, ESR may change little.

ECG: always changed, the T wave is significantly reduced and S-T interval in many leads, sometimes in all, a negative T wave is possible, atrioventricular blocks are often recorded various degrees, blockade of the legs of the bundle of His, extrasystoles, paroxysmal tachycardia, atrial fibrillation and flutter.

X-ray of the heart: cardiomegaly, decreased cardiac tone.

Echocardiography reveals cardiomegaly, dilatation of various chambers of the heart, decreased cardiac output, signs of total myocardial hypokinesia in contrast to local hypokinesia in IHD.

Intravital myocardial biopsy: picture of inflammation.

Thus, mild myocarditis is characterized by focal lesion myocardium, normal boundaries heart, lack of circulatory failure, low severity of clinical and laboratory data, favorable course. Moderate-severe myocarditis is manifested by cardiomegaly, the absence of congestive circulatory failure, the multifocal nature of the lesion, and the severity of clinical and laboratory data. Severe myocarditis is characterized by diffuse lesion myocardium, severe course, cardiomegaly, severity of all clinical symptoms, congestive insufficiency circulation.

Diagnostic criteria(Yu. I. Novikov, 1981)

Previous infection, proven by clinical and laboratory data (including isolation of the pathogen, results of the neutralization test, CSK, TPHA, increased ESR, the appearance of PRP), or another underlying disease ( drug allergy and etc.).

plus

Signs of myocardial damage

I. "large":

• 1. Pathological changes in the ECG (rhythm, conduction, changes S-T interval and etc.)
• 2. Increased activity of sarcoplasmic enzymes and isoenzymes in blood serum (AsAT, LDH, CPK, LDH1-2)
• 3. Cardiomegaly, according to X-ray and ultrasound studies
• 4. Congestive heart failure or cardiogenic shock

II. "small":

• 1. Tachycardia
• 2. Weakened 1 tone
• 3. Gallop rhythm

Combinations of a previous infection or other disease, according to the etiology, with any two "small" and one<большим» или с любыми двумя «большими» признаками достаточно для диагноза миокардита.

Formulation of the diagnosis

The clinical diagnosis of myocarditis is formulated taking into account the classification and main clinical features of the course: the etiological characteristics are indicated (if it is possible to accurately establish the etiology), the severity and nature of the course, the presence of complications (heart failure, thromboembolic syndrome, rhythm and conduction disturbances, etc.).

Examples of the formulation of the diagnosis

• 1. Viral (Coxsackie) myocarditis, moderate form, acute course, extrasystolic arrhythmia, atrioventricular block I stage. But.
• 2. Staphylococcal myocarditis, severe form, acute course, left ventricular failure with attacks of cardiac asthma.
• 3. Non-rheumatic myocarditis, mild form, acute course, H 0 .

Diagnostic Handbook of Therapist. Chirkin A. A., Okorokov A. N., 1991

Non-rheumatic myocarditis (NM) is a disease that is characterized by the occurrence of an inflammatory process in the heart muscle. How to recognize the above ailment? How to properly treat NM and how to prevent its occurrence? The answers to these questions can be found in this article.

Classification and causes

Children are more susceptible to the development of non-rheumatic myocarditis, but this disease occurs in all age categories of the population. Various factors contribute to the occurrence of the disease in question. Most often, the main reasons are:

In the vast majority of cases, the main cause of this disease is allergies and various viruses.

In some cases, non-rheumatic myocarditis may occur as a complication of lupus, scleroderma, or infectious endocarditis. Also, specialists have registered cases of NM occurrence for no apparent reason.

Symptoms may vary depending on the location of the inflammatory process, but there are several common signs:

• painful sensations of a different nature in the chest area;
• a significant increase in body temperature;
• feeling of heat;
• convulsions;
• malaise;
• drowsiness;
• various cardiac arrhythmias (palpitations, rhythm disturbance, shortness of breath, increase in the volume of interstitial fluid);
• change in the healthy shade of the fingertips;
• leg swelling.

Complications and consequences

Often, non-rheumatic myocarditis in mild and moderate form, subject to timely access to specialists, responds well to treatment and does not cause complications and consequences. However, in the absence of proper treatment or the presence of a severe form of the disease, a not very favorable prognosis is possible. With a complicated form of NM, intoxication, impaired blood circulation, sclerosis, and deformation of the valvular apparatus are possible. Often, a severe stage of the disease is accompanied by an inflammatory process of the serous membrane of the heart.

Also, complications include cardiosclerosis, which leads to a stable violation of the heart rhythm and a tendency to form blood clots.

The consequences include chronic heart failure, which, if left untreated, progresses and can lead to death. In some cases, with this disease, arrhythmia occurs, to eliminate which the patient is fitted with a pacemaker.

Non-rheumatic myocarditis is also characterized by a recurrent latent form, which often progresses without pronounced symptoms, therefore, after treatment during the rehabilitation period, experts recommend observation by a cardiologist for 12 months after recovery, regular testing, and strengthening the immune system.

Most often, children acquire the above ailment as a complication after viral infections, regardless of age. In some cases, non-rheumatic myocarditis can develop while still in the womb.

Symptoms are almost the same as in adults, and depend on the severity of the disease. At mild form perhaps a slight increase in heart rate, a decrease in the strength of myocardial contractions and rhythm disturbance.

In the presence of moderate form in young patients, fatigue and difficulty breathing are observed, especially during physical exertion. Also, on examination, heart murmurs and wheezing in the lungs, cardiac arrhythmia, a significant increase in the liver and a pronounced decrease in the strength of contractions of the heart muscle are found.

At severe form respiratory distress is noted at rest, not only the work of the heart muscle is disturbed, but also blood circulation, an increase in the heart, hypotension and arrhythmia are observed, while the pulse is poorly heard due to weak contractions. The liver is greatly enlarged and painful on palpation.

Cardiologists are also involved in the treatment of non-rheumatic myocarditis in children. It is performed according to the same principle as in adult patients, drugs and dosage for children are prescribed according to age.

In the vast majority of cases, with timely and proper treatment of NM, children fully recover without any complications and consequences. Full recovery occurs from 6 to 24 months after the start of treatment.

In some cases, such an ailment can develop into a chronic form, so children need to be regularly monitored by a specialist, undergo examinations in a timely manner and be vaccinated against various diseases (provided there are no allergic reactions and only with the permission of the treating specialist).

Also, after an illness, young patients are recommended to attend physical therapy classes to restore the proper functioning of the cardiovascular system. During rehabilitation, foods that can cause allergic reactions should be excluded from the child's diet.

Diagnosis of the disease

It is rather difficult to diagnose this disease, therefore, if NM is suspected, the patient undergoes a fairly extensive series of studies and analyzes.

To make a diagnosis, you should contact your family doctor, who measures the heart rate, checks for abnormalities in the work of the heart muscle and the degree of swelling. Then he sends for blood tests (general, biochemical, immunological, blood culture for sterility, PCR). The patient is also referred for echocardiography to study the heart rhythm and changes in the work of the heart muscle.

Additionally, an x-ray of the lungs is prescribed to study the condition of the heart, as well as possible congestive processes in the lungs. To obtain a more complete clinical picture, an endomyocardial biopsy may be required, which is used to diagnose and evaluate the development of inflammation. To make an accurate diagnosis, the patient is sent for scintigraphy and magnetic resonance imaging of the heart muscle (to identify the location of the inflammatory process).

Traditional treatment

The choice of therapy depends on the stage of development of the disease, which are distinguished by several:

• acute;
• subacute;
• protracted;
• chronic.

At acute stage the patient is necessarily sent for inpatient treatment in a hospital. Treatment is carried out by cardiologists in the relevant department. The patient should limit as much as possible any physical activity on the body and observe bed rest for an average of 1-2 months until the restoration of normal cardiac activity.

Subacute stage characterized by a gradual deterioration of the patient's condition and a longer recovery process. Depending on the severity of the disease, both inpatient and home treatment is possible.

lingering form, often occurs when untimely access to specialists or improper treatment of NM. Can go to chronic, in which both periodic exacerbations of varying degrees and stages of relative remission are possible.

Regardless of the stage and form of the disease, it is necessary to observe dietary restrictions, namely, to reduce the amount of salt in the daily diet as much as possible, not to drink a lot of water and to adhere to a protein diet to speed up the healing process.

Depending on the causative agent of the disease, appropriate drugs:

• antiviral ("Interferon", "Viferon");
• anti-inflammatory ("Ibuprofen", "Movalis", "Indomethacin", "Aspirin");
• to relieve puffiness ("Suprastin", "Claritin");
• steroid medications ("Prednisolone").

To improve the regeneration of the heart muscle, Panangin, Asparkam, Riboxin can be additionally prescribed, for the prevention of various complications - Clexane, Fraxiparin, Plavix, Egithromb.

The duration of treatment and dosage of the above drugs depends on the stage and form of the disease and varies from 1 to 6 months.

All these drugs are provided for informational purposes only, before taking medicines, you should consult a specialist.

Treatment with folk remedies

For the treatment of non-rheumatic myocarditis, various folk recipes are used as additional means:

1. Infusion of arnica flowers. 2 small handfuls of flowers of this plant are poured into 400 ml of boiling water, covered with a lid and infused for 60 minutes. You need to take 1 tablespoon, diluted with milk 1: 1 after meals three times a day for 30 days in a row.

Also, a vodka tincture is prepared from the above plant. 2 handfuls of flowers pour 1 glass of vodka. Tightly close in a glass jar and incubated for 1 week. After the expiration of the term, use 35-40 drops of strained tincture 3 times a day after meals.

1. Medicinal collection of herbs. Ingredients:

• lily of the valley - 2 tablespoons;
• fennel (fruits) - 4 tablespoons;
• valerian - 8 tablespoons.

This mixture is poured with boiling water in an amount of 1.5 liters. After complete cooling, the infusion is carefully filtered and consumed half a cup three times a day after meals.

1. Alcohol tincture. 250 g of chopped lemon pulp, 120 g of chopped figs, half a glass of honey, 50 ml of vodka insist for a week, use 1 teaspoon in the morning and evening after meals.
2. Tincture for myocardial edema. To restore the normal function of the heart muscle, the people use the following recipe: 1 tablespoon of honey and juice of a medium-sized lemon are added to 1 glass of birch sap. This mixture is used 1 time per day for 14 days.

Additionally, in alternative medicine, it is recommended to consume several tablespoons of honey daily, brew strawberry tea, add walnuts and raisins to the diet. Also, to normalize the work of the heart, a decoction of wild rose and hawthorn is used. But all of the above remedies from traditional medicine should be used only after consultation with your doctor.

Prevention

At the moment, there are no special means to prevent the development of non-rheumatic myocarditis. But experts have compiled a list of recommendations that help strengthen both the cardiovascular system and the body as a whole:

• fortified proper nutrition;
• refusal to use alcoholic beverages and cigarettes;
• regular exercise;
• timely access to specialists for the treatment of various ailments;
• compliance with preventive measures during viral epidemics.

Since most often non-rheumatic myocarditis develops as a complication after various viral and bacterial ailments, various vaccines against influenza, rubella and other diseases are a good preventive measure.

Inflammation of the heart muscle is a rather dangerous disease, which, if not properly treated, can lead to the death of the patient. Therefore, for a complete cure and the absence of various consequences, it is necessary to follow all the recommendations of specialists, and during the rehabilitation period, regularly undergo examinations and strengthen immunity.

Myocarditis is a focal or diffuse inflammation of the heart muscle as a result of various infections, exposure to toxins, drugs, or immunological reactions, leading to damage to cardiomyocytes and the development of cardiac dysfunction.

Etiology.

The division of myocarditis into rheumatic (due to streptococcal infection) and non-rheumatic (viral) is the first stage of diagnosis.
Rheumatic myocarditis is an obligatory component of rheumatic carditis (rheumatic carditis), along with endocarditis and pericarditis. Under consideration
in acute rheumatic fever.
The cause of non-rheumatic myocarditis in the vast majority of cases is viral infection(influenza viruses, parainfluenza, Coxsackie B, infectious hepatitis, ECHO, cytomegaloviruses, etc.).

Pathogenesis.

Viral infection at the stage of active virus replication triggers immunopathological reactions involving cytotoxic cells, autoantibodies to various components of cardiomyocytes, which leads to their damage (hypothesis of autoimmune damage).
Criteria for diagnosis.
I. Connection with past infection, proven by clinical and laboratory data: pathogen isolation, results of neutralization reaction, complement fixation reaction, hemagglutination reaction, ESR acceleration, appearance of C-reactive protein.
II. Signs of myocardial damage.
Violation of repolarization processes in the area of ​​the anterior wall
Big signs:
- Violation of the repolarization processes on the ECG - a change in the final part of the ventricular complex in the form of ST segment depression and the appearance of a low-amplitude, smoothed or negative T wave, which, as a rule, are determined in chest leads, but can also occur in standard
- Rhythm and conduction disorders
- Increased activity of cardioselective serum enzymes and isoenzymes (LDH and LDH1, CK and MB-CKF, troponin T and I).
- Cardiomegaly
- Heart failure
Small signs:
- tachycardia
- weakening of the 1st tone (it is important to confirm during phonocardiography)
- gallop rhythm

Treatment.

1. Etiotropic treatment. The method of treatment of non-rheumatic myocarditis with antiviral agents has not yet been developed. Patients with bacterial myocarditis
arising during a sore throat (or other streptococcal infection), or shortly after its completion, treatment with penicillin 1 million U / m is prescribed 8
once a day or semi-synthetic penicillins (amoxicillin) at a daily dose of 2-3 g / day or macrolides (clarithromycin 1.0 per day) for 7-10 days.
2. More recently, non-steroidal anti-inflammatory drugs have been considered the basis of pathogenetic treatment. However, at present, given the lack of evidence of their positive effect on the outcome of the disease, slowing down the reparative processes in the myocardium as a result of their use, this group of drugs in the treatment of myocarditis is not recommended.
- Therapeutic (bed) regimen for acute myocarditis is considered a pathogenetic method of treatment and is mandatory until the manifestations of a viral infection stop.
— Glucocorticoids, having a pronounced anti-inflammatory and immunosuppressive properties, are indicated for severe myocarditis and the development of myopericarditis. Prednisolone is most often prescribed at a dose of 20-30 mg per day for 2-3 weeks, depending on the severity of the clinical manifestations of the disease.
— Anticoagulants are indicated for myocarditis with high clinical and laboratory activity. They have anticoagulant, anti-inflammatory
and antihypoxic action. Heparin is prescribed 10,000 IU 2 times a day s / c for 7-10 days.
- Metabolic therapy aims to improve metabolism and tissue respiration in the myocardium, thereby reducing dystrophic processes. Riboxin, panangin, anabolic drugs, cytochrome C, preductal, mildronate are prescribed. These drugs do not cause harm, are psychologically well perceived by patients and are highly valued by them.

Myocarditis is an acute, subacute or chronic inflammatory lesion of the myocardium of predominantly infectious and (or) immune etiology, which can manifest itself with general inflammatory, cardiac symptoms (cardialgia, ischemia, heart failure, arrhythmia, sudden death) or proceed latently.

Myocarditis is characterized by a large variability of the clinical picture; often it is combined with pericarditis (the so-called myopericarditis), it is also possible simultaneous involvement in the inflammatory process of the endocardium. For the convenience of distinguishing between rheumatic and other variants of myocarditis, the term "non-rheumatic myocarditis" is used.

Myocarditis, accompanied by expansion of the cavities of the heart and contractile dysfunction of the myocardium, is included in the American classification of primary cardiomyopathies (2006) under the name "inflammatory cardiomyopathy". This term was proposed in order to distinguish among patients with severe dilatation of the heart chambers (DCMP), those who have an inflammatory process at the heart of the disease, subject to specific treatment (as opposed to patients with genetic DCM).

Myocarditis may be an independent condition or a component of another disease (eg, systemic scleroderma, systemic lupus erythematosus, IE, systemic vasculitis, etc.).

Epidemiology

The true prevalence of myocarditis is unknown due to the difficulty of verifying the diagnosis. According to some reports, the frequency of diagnosis of "myocarditis" in cardiological hospitals is about 1%, at autopsy in young people who died suddenly or as a result of injuries - 3-10%, in infectious diseases hospitals - 10-20%, in rheumatology departments - 30 -40%.

Classification

The classification of myocarditis, proposed in 2002 by N.R. Paleev, F.N. Paleev and M.A. Gurevich, is built mainly according to the etiological principle and is presented in a slightly modified form.

Infectious and infectious-immune.

Autoimmune:

Rheumatic;

With diffuse connective tissue diseases (SLE, rheumatoid arthritis, dermatomyositis, etc.);

With vasculitis (nodular periarteritis, Takayasu's disease, Kawasaki's disease, etc.);

With other autoimmune diseases (sarcoidosis, etc.);

Hypersensitivity (allergic), including medicinal.

Toxic (uremic, thyrotoxic, alcoholic).

Radiation.

Burn.

Transplant.

Unknown etiology (giant cell, Abramov-Fiedler, etc.).

Bacteria (Brucella, Clostridia, Diphtheria Corynebacterium, Gonococcus, Haemophilus influenzae, Legionella, Meningococcus, Mycobacterium, Mycoplasma, Streptococcus, Staphylococcus), Rickettsia (Rocky Mountain Fever, Cool fever, Tsutsugamushi fever, rash) can act as an etiological agent of infectious myocarditis. typhus), spirochetes (borrelia, leptospira, pale treponema), protozoa (amoebae, leishmania, toxoplasma, trypanosomes that cause Chagas disease), fungi and helminths.

The most common causes of infectious myocarditis are adenoviruses, enteroviruses (Coxsackie group B, ECHO), herpes group viruses (cytomegalovirus, Epstein-Barr virus, herpes virus type 6, herpes zoster), HIV, influenza and parainfluenza viruses, parvovirus B19, as well as viruses of hepatitis B, C, mumps, poliomyelitis, rabies, rubella, measles, etc. It is possible to develop a mixed infection (two viruses, a virus and a bacterium, etc.).

Myocarditis in infectious diseases may not be of great clinical significance, develop as part of a multiple organ lesion (typhus, brucellosis, borreliosis, syphilis, HIV infection, infection with hepatitis C virus, cytomegalovirus) or come to the fore in the clinical picture and determine the prognosis (myocarditis diphtheria, enterovirus infection, other viral myocarditis and Chagas disease).

With infectious (especially viral) myocarditis, the development of autoimmune reactions is typical, and therefore it can be difficult to distinguish between infectious and infectious-immune myocarditis.

Three variants of myocarditis are distinguished along the course:

spicy- acute onset, pronounced clinical signs, fever, significant changes in laboratory (acute phase) parameters;

subacute- gradual onset, protracted course (from a month to six months), a lesser degree of severity of acute phase indicators;

chronic- long course (more than six months), alternation of exacerbations and remissions.

According to the severity of the course, the following variants of myocarditis are distinguished:

easy- mild, proceeds with minimal symptoms;

moderate- moderately pronounced, the symptoms are more distinct, slightly pronounced signs of heart failure are possible);

heavy- pronounced, with signs of severe heart failure;

fulminant (lightning fast), in which extremely severe heart failure, requiring immediate hospitalization in the intensive care unit and resuscitation, develops in a matter of hours from the onset of the disease and often ends in death.

According to the prevalence of the lesion, the following variants of myocarditis are distinguished:

focal- usually does not lead to the development of heart failure, can manifest only rhythm and conduction disturbances, presents significant difficulties for diagnosis;