Treatment of acute myocarditis in adults and children: clinical recommendations
Myocarditis is a lesion of the myocardium (heart muscle) of an inflammatory nature. The classification of myocarditis is developed taking into account the causes, pathogenesis, development of the disease and some other factors.
The main types of myocarditis:
- infectious (bacterial, viral and others);
- allergic (medical, post-vaccination, etc.);
- autoimmune-allergic - for example, post-influenza;
- collagenous or rheumatic (in rheumatism, SLE, scleroderma and other connective tissue diseases);
- Diphtheria. 25-30% of patients are diagnosed with diphtheria "Myocarditis";
- toxic (may be the result of intoxication of the body with medicinal preparations, narcotic substances);
- idiopathic (of unclear etiology).
According to the course, acute and chronic (recurrent) myocarditis are distinguished. The disease can be diffuse or focal.
Symptoms of infectious myocarditis
Manifestations of pathology depend on the site of myocardial damage. A small cell in the conduction system of the heart can cause vivid symptoms, and a significant lesion of a "less important" area of the myocardium can proceed with unexpressed symptoms.
Viral myocarditis - what is it? Symptoms of acute myocarditis usually appear after a SARS.
Observed:
- shortness of breath;
- tachycardia;
- pains in the heart.
Symptoms of infectious myocarditis are often disguised as manifestations of the underlying disease. Patients complain of fever, weakness, which are manifestations of general intoxication of the body. With diffuse myocarditis, the impressions are more serious - dilatation (expansion) of the chambers of the heart and congestive heart failure can be noted. An ECG in diffuse myocarditis records signs of hypertrophy of the heart, a decrease in the amplitude of the ECG waves is observed. ECG changes are more pronounced in idiopathic and infectious-allergic myocarditis. Symptoms of rheumatic myocarditis are similar to symptoms of other forms of the disease. Patients complain of shortness of breath, pain in the heart, and an increase in body temperature.
Diagnosis of myocarditis in children
At auscultation, tachycardia, weakening of the first heart sound, protodiastolic rhythm of gallop, systolic noise of mitral regurgitation are often determined. Changes on the ECG can be observed even in the absence of clinical symptoms of myocarditis. Daily Holter ECG monitoring allows you to determine changes in the size of the heart cavities. Echocardiography is mainly used for differential diagnosis of myocarditis in children with congenital defects and other heart pathologies.
According to the recommendations of the American Heart Association, the diagnosis of myocarditis in children should be carried out taking into account major and minor criteria.
The first include:
- appearance of symptoms of myocarditis within 10 days after an infectious disease;
- congestive heart failure;
- changes on the ECG;
- complete AV block (3rd degree atrioventricular block).
Minor criteria include:
- confirmation of a transferred infectious disease;
- tachycardia;
- weakening of the I tone;
- gallop rhythm.
To confirm the diagnosis of "Myocarditis" it will be necessary to identify one or two major and two minor criteria. Non-rheumatic myocarditis in a child is diagnosed based on the results of an immunological blood test, chest x-ray and ultrasound of the heart.
Clinical recommendations for myocarditis
Treatment of acute myocarditis in adults is carried out using anti-inflammatory and antibacterial therapy. Timely assessment of the effectiveness of the prescribed treatment is important, and if necessary, its correction.
Clinical recommendations for myocarditis:
- antibiotics (for myocarditis of an infectious nature);
- anti-inflammatory drug therapy (nonsteroidal anti-inflammatory drugs (NSAIDs), glucocorticoids);
- antihistamine drugs;
- antiarrhythmic drugs;
- anticoagulants.
Glucocorticosteroids for myocarditis are prescribed in case of:
- acute myocarditis, which is accompanied by fever (in the absence of results from the use of NSAIDs);
- autoimmune myocarditis;
- acute infectious-allergic myocarditis.
Read about how to treat complications of allergic myocarditis on our website https://dobrobut.com.
In most cases, myocarditis ends with complete recovery. The prognosis for patients with residual symptoms (heart failure, heart rhythm disturbances) depends on age and concomitant pathologies.
Treatment of chronic myocarditis
One of the main causes of chronic myocarditis is participation in the pathological process of intracellular pathogens, which significantly complicates the complete rehabilitation of the body. In most cases, myocarditis occurs against the background of chronic focal infection - tonsillitis, periodontitis, sinusitis, adnexitis, prostatitis, cholecystitis. Constant intoxication and sensitization of the body are considered an unfavorable background for the development and progression of chronic myocarditis.
Etiotropic treatment of inflammatory processes caused by extracellular bacteria does not cause difficulties. The presence of a chronic infection affects the development of the pathological process, which requires the appointment of repeated courses of antibiotics, antiviral drugs and immunomodulators. Their use is also appropriate for relapses of chronic myocarditis. In the period of remissions, a course of prophylactic therapy with the IRS-19 drug is recommended. Preventive vaccine therapy is prescribed to reduce the risk of SARS.
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