The heart is one of the main organs. This is where the circulation begins. Also, large vessels flow into the heart muscle, giving rise to all the arteries and veins in the body. Therefore, cardiac diseases remain one of the most severe and occupy the first place in the list of causes of death. Heart pathologies occur with the same frequency both in the adult population and among children. One of the acquired diseases is viral myocarditis. To a greater extent, this ailment refers to the problems of pediatrics, but occurs in adults.
The course of the disease can be acute or chronic. In some cases, patients do not even know about the presence of pathology, since the disease does not actively manifest itself. Despite the absence of severe symptoms, treatment of myocarditis should be started as soon as possible. After all, this disease is one of the causes of heart failure in both adults and children.
Viral myocarditis: causes
Myocarditis refers to inflammation of the heart muscle, leading torhythm and conduction disturbances. Often the disease occurs as a result of viral infections. In other words, myocarditis is a complication of various pathologies. Pathologies preceding inflammation of the heart muscle include:
- Infections caused by Coxsackie B.
- Polio.
- Different types of flu.
- Infections caused by viruses of the ECHO group.
- Herpes.
- Diphtheria.
- Enterovirus infection.
- Scarlet fever.
- HIV infection.
Any of these diseases leads to a decrease in the immune response and can provoke the development of myocarditis of viral etiology. According to statistics, this disease is about 10% of all cardiac pathologies. In pediatric practice, there are 2 peaks of morbidity. These include the infancy period and the age of 6-7 years. Among the adult population, mainly young people suffer from this disease. The average age of patients is between 30 and 40 years old.
In most cases, myocarditis is caused by the Coxsackievirus. This pathogen is the cause of the disease in 50% of cases. This virus has a tropism for cardiomyocytes. It not only quickly penetrates into the myocardium, but also multiplies in it. Therefore, the pathogen often causes a subacute and chronic form of inflammation. In addition, influenza viruses A and B have tropism for the heart muscle. Others are less likely to cause the disease. The most dangerous pathologies that provoke inflammation of the heart include diphtheria, sepsis andscarlet fever. They are the cause of acute viral myocarditis. Most often, the causative agents of these pathologies lead to heart complications in patients with reduced immunity. Acute inflammation of the myocardium can lead to death. In addition to these diseases, enterovirus infection, which is often found in children, is a great danger.
Mechanism of myocarditis
In most cases, viruses enter the body through the respiratory tract. They settle on the mucous membranes of the sinuses or throat, and later invade the cells. Viruses multiply rapidly, causing a local inflammatory process. Some pathogens enter the gastrointestinal tract through contaminated food. With a decrease in the immune response, harmful agents enter the bloodstream. Thus, viruses penetrate first into the cardiac vessels, and then into the myocardium. This leads to the activation of a number of processes. The pathogenesis of viral myocarditis includes the following steps:
- Introduction and reproduction of the pathogen in the heart muscle.
- The action of toxins on cardiomyocytes.
- Activation of immune defenses and production of autoantibodies.
- Lipid peroxidation.
- Apoptosis of cardiomyocytes.
- Electrolyte disturbances.
When hit, the virus binds to receptors located on the surface of cardiac cells. As a result, damage to the structure of the myocyte occurs. Cardiotropic viruses multiply rapidly and infect more and more heart muscle cells. The harmful effects of pathogens are due to the fact that they secretetoxic substances. Thus, an inflammatory reaction and dystrophy of the cellular elements of the myocardium develops.
Such changes lead to the activation of the body's defenses. Immune cells begin to react to ongoing disorders and secrete antibodies. Unfortunately, such protection not only fights the pathogen, but also the destroyed cardiomyocytes. As a result, immune cells begin to perceive the tissues of the heart muscle as foreign particles. This reaction only exacerbates cell damage. The inflammatory process triggers a complex biochemical reaction - lipid peroxidation. As a result, free radicals are formed in the cells, which irreversibly damage myocardial tissue.
As the disease progresses, pathological reactions worsen. The next stage in the development of viral myocarditis is apoptosis. It is a cell death programmed at the genetic level. All of these disorders lead to hypoxia of uninfected cardiomyocytes and the development of acidosis. Thus, the electrolyte balance in the cells is disturbed and potassium is lost. Deficiency of this chemical element entails serious consequences. In addition to the inflammatory process and impaired contractility of the heart, rhythm and conduction disturbances develop.
Classification of the pathological condition
All over the world there is a single classification of diseases (ICD-10), which includes various pathological conditions. Among them is viral myocarditis. ICD-10 is a classification in whichEach disease is assigned a specific code. The diagnosis of "viral myocarditis" has the code I41.1.
The disease differs in the course of the pathological process, depending on the time of persistence of the pathogen in the body. According to this classification, they distinguish:
- Acute myocarditis. It is characterized by the presence of a pronounced intoxication syndrome. During the first 2 weeks, there is an increase in body temperature, runny nose, headache. After 14 days, symptoms of inflammation of the heart muscle begin to appear.
- Subacute myocarditis. This diagnosis is made when the duration of the disease is less than 6 months. Symptoms of inflammation are less pronounced than in acute myocarditis. However, there are signs of chronic heart failure.
- Chronic myocarditis. The course of the pathology takes more than six months. In a chronic process, signs of exacerbation are replaced by the complete disappearance of symptoms. However, with this form of myocarditis, organic changes in the heart muscle occur, namely sclerosis and dilatation.
Another type of the course of the disease is chronic persistent inflammation. It is characterized not only by the disappearance of the clinical picture of the pathology, but also by the restoration of normal heart activity. Despite this, this condition is called borderline inflammation, since heart failure can develop at any time in the future. Therefore, persistent viral myocarditis is considered one of the most dangerous forms. Symptoms and treatment of the disease directly depend on the nature of the pathology. Therefore, it is important to determine the form of the inflammatory process in time.
Symptoms of the disease in adults
Myocarditis caused by viruses can develop in people of any age with a decrease in immunity or under the influence of other provoking factors, such as stress. The clinical picture in the first days of the disease does not have any connection with the signs of heart disease. Therefore, pathology is diagnosed after the inflammatory process begins in the myocardium. Symptoms depend on the extent of the lesion. If a small area of \u200b\u200bthe heart muscle is inflamed, then there may be no clinical manifestations. With extensive damage, there is severe pain and shortness of breath.
Most often, pathology is observed in middle-aged people - from 30 to 40 years. How to suspect viral myocarditis? Symptoms of the disease rarely begin suddenly. They are usually preceded by a clinical picture of infection. Symptoms of the disease differ depending on the type of virus. The most common symptoms are fever, headache, runny nose, watery eyes, sore throat and general weakness. In some types of infections, disorders of the digestive tract come first. 2 weeks after the onset of the disease, cardialgia occurs. The pain in the heart is constant. The severity of discomfort depends on the prevalence of viral myocarditis. Symptoms in adults are less pronounced than in children. In the subacute and chronic course of the disease, patients complain of shortness of breath. In somecases, this is the first sign that a person pays attention to. However, shortness of breath indicates the development of heart failure and the transition of the disease into a protracted form.
Features of the course of pathology in children
Viral myocarditis in children is common in cardiology practice. Symptoms are not much different from the manifestations of the disease in adults. However, there are some features of the course of the disease. Unlike adults, symptoms in children depend not only on the prevalence of the inflammatory process, but also on the age of the child. The disease is especially severe during the neonatal period. The disease is accompanied by intoxication, refusal to feed and the appearance of cyanosis. The baby's skin acquires a bluish tint, the child constantly cries and does not sleep. With the progression of the disease, swelling and shortness of breath are noted even at rest.
Viral myocarditis in young children has the same manifestations. In addition, children often complain of pain in the abdomen and chest, sometimes the pathology is accompanied by a cough. Preschool age is considered the peak of viral myocarditis. Symptoms of the pathological process become more similar to the clinical picture observed in adults. The main complaints include fever, muscle pain and weakness. Then unpleasant tingling sensations in the region of the heart join. Children quickly get tired of games and physical education. This is due to increasing shortness of breath associated with disruption of the heart.
Diagnosis of the disease in adults and children
How to detectviral myocarditis? Diagnosis of this pathology begins with an examination and physical examination of the patient. The main method to suspect myocarditis is auscultation of the heart valves. When listening with a phonendoscope, a decrease in the sonority of the 1st and 2nd tones is noted. The appearance of systolic murmur indicates the defeat of the mitral valve. With severe inflammation of the myocardium, splitting of the 1st tone is heard. Chronic disease is accompanied by heart failure and dilatation of the left ventricle. Auscultatory similar complication is expressed in the appearance of diastolic murmur.
Laboratory diagnostics include UAC, a biochemical blood test. With inflammation, leukocytosis, lymphocytosis and neutropenia, an increase in the level of C-reactive protein, fibrinogen, and an acceleration of ESR are observed. An increase in the size of the heart is indicated by percussion and ECG data. The lesion of the valvular apparatus is noticeable during an ultrasound examination - echocardioscopy.
Immunological diagnostics is carried out to identify the etiological factor. It allows you to determine the titer of antibodies to certain types of viruses. The material for analysis is biological fluids, in most cases blood. PCR is also performed to isolate DNA and RNA of the pathogen.
Performing a differential diagnosis
The appearance of pain in the heart may indicate various cardiac diseases. First of all, myocarditis is differentiated with a heart attack and angina pectoris. According to the clinical picture, these pathologies differ in the intensity and nature of pain. With myocardial ischemia, unpleasantsensations come on suddenly and increase over minutes or hours. The pain is localized behind the sternum and radiates to the left arm and shoulder blade. In some cases, angina pectoris or small focal infarction have less pronounced symptoms. Special studies help to rule out ischemia, in particular ECG and venous blood test for troponins.
In addition to angina pectoris and heart attack, myocarditis should be differentiated from other diseases accompanied by heart failure. These include acute and chronic rheumatic fever. This disease is accompanied by damage to the valvular apparatus of the heart. Unlike infectious myocarditis, rheumatism has other characteristic symptoms. These include skin erythema, behavioral changes (chorea minor), and joint damage.
Sometimes pain in the region of the heart occurs with pathologies of the digestive and nervous systems. Cardialgia can be confused with an exacerbation of chronic pancreatitis or the initial period of herpes zoster. With these pathologies, changes in the ECG and EchoCG will not be observed. In addition, normal, unchanged tones will be heard during auscultation of the heart.
Viral myocarditis: treatment of the disease
Despite the fact that the cause of infectious myocarditis can be identified, etiological therapy is rarely used. This is due to the fact that the pathogen has entered the cells and the heart has already been damaged. Therefore, the treatment of viral myocarditis is aimed at the pathogenesis of the disease. To improve the patient's condition and stop the developmentpathologies are prescribed non-steroidal anti-inflammatory drugs. Among them are the medicines "Indomethacin", "Diclofenac". They not only eliminate inflammation, but are also pain relievers. As the disease progresses, small doses of hormones are used. These include the drug "Prednisolone".
Treatment of chronic viral myocarditis is aimed at combating heart failure. For this purpose, cardioprotectors are prescribed, for example, the drug "Preductal". Vitamins for the heart and antiplatelet agents are also needed. With edematous syndrome, the use of diuretics is indicated. Severe arrhythmias require a pacemaker.
Recovery period after myocarditis
Because the disease often becomes chronic, adequate recovery after myocarditis is required to avoid exacerbations. Patients are shown physical and psycho-emotional peace. It is required to exclude s alty foods from the diet and add foods rich in potassium. It is recommended to eat lean meat and fish, fresh vegetables and fruits, kefir, baked potatoes, nuts.
Young women are interested in the question: is it possible to get pregnant with viral myocarditis? It depends on the severity of the disease. Naturally, with an exacerbation of the inflammatory process, pregnancy is contraindicated, since it can lead to a deterioration in the condition of the expectant mother and abnormalities in the fetus. As you recover and recover, you can think about replenishment. However, pregnancy should be planned together with a gynecologist andby a cardiologist after a complete examination.
Primary prevention of myocarditis
In order to prevent the development of myocarditis, generally accepted preventive measures should be followed. First of all, it is necessary to avoid catarrhal pathologies and take antiviral agents in a timely manner in case of infection. Additional methods include: walking and airing the premises, wet cleaning, taking vitamins and giving up bad habits.
