Myocarditis in a child is relatively often diagnosed in modern medical practice. It should immediately be said that this disease is dangerous and, if left untreated, can lead to serious complications. That is why many parents are interested in information about this disease. Why does such an ailment develop even in infants and what symptoms should be paid attention to? What does therapy look like and what are the prognosis for young patients?
Features and characteristics of the disease
The term "myocarditis" means a disease that is accompanied by an inflammatory process in the heart muscle. This disease is diagnosed in patients of different ages. Myocarditis in a child or adolescent is unlikely to be considered rare.
The causes of inflammatory myocardial damage can be very different, ranging from penetration into the tissues of the infection and ending withsevere allergic reactions and intoxications. Quite often, inflammation covers not only the heart muscle, but also neighboring structures, including the pericardium, blood vessels and other organs.
Main causes of myocarditis
It is believed that inflammation of the heart muscle can be associated with almost any known form of infection:
- In most cases, the "culprits" of myocarditis are viruses - adenoviruses, Coxsackie enteroviruses, as well as parvoviruses, cytomegalovirus, hepatitis and influenza viruses.
- Inflammation of the myocardium sometimes has a bacterial origin. The disease develops against the background of tuberculosis, brucellosis, bacterial meningitis. The inflammatory process appears when a streptococcal infection is activated.
- The defeat of the body by rickettsia often leads to inflammation of the heart muscle. Risk factors include Q fever, typhus, and Rocky Mountain fever.
- Pathogenic fungi, in particular, fungi of the genus Candida, can act as a pathogen.
- There are also protozoan myocarditis developing against the background of toxoplasmosis, malaria, leishmaniasis.
- Helminths (Echinococcus, Trichinella) also provoke inflammation.
- There is also toxic myocarditis caused by the ingestion of arsenic, mercury, carbon monoxide.
- Sometimes the disease develops on the background of taking medications, after vaccination or administration of sera.
- Risk factors include snake and insect bites.
- Physical impact, for example,severe hypothermia, overheating, exposure to ionizing radiation on the body also provokes an inflammatory process.
- Other risk factors include systemic lupus erythematosus, rheumatoid arthritis and some other autoimmune diseases.
As you can see, there are a huge number of reasons why myocarditis develops. Diagnosis should include the search for the primary disease, as the success of therapy depends on this.
Forms and varieties of the disease
There are several classification schemes for this disease. The variants of the development of the disease depending on the cause have already been considered above. But during the diagnosis, experts pay attention to other factors:
- If we are talking about the course of the disease, then myocarditis can be acute, chronic or subacute.
- Depending on the severity of the disease, the disease can be mild, moderate or severe.
- The doctor also pays attention to the clinical manifestations - in children you can notice a typical form of inflammation, as well as an erased and asymptomatic one.
- The degree of spread of the inflammatory process also matters - in this case, focal (there is an isolated, single area of inflammation) and diffuse myocarditis (the pathology extends to the entire muscle) is distinguished.
How does myocarditis develop in children? Main Stages
Myocarditis in a child develops in several stages - three stages are distinguished in modern medicine:
- Viraemia stage - viral particles (orother pathogens) enter the myocardium. First, they are fixed on the surface of muscle cells, and then penetrate into the myocytes. At this stage, activation of the immune system is observed, which is accompanied by increased synthesis and release of interferon.
- Autoimmune stage, in which the immune cellular response is significantly enhanced and the level of anticardiac antibodies that accumulate in the myocardium increases, negatively affecting its work. At the same stage, inflammatory mediators are activated. There is damage to microvessels.
- If the course of the disease is favorable, then there is a decrease in edema and the formation of fibrous areas on the heart muscle. If the therapy did not give positive results (or was completely absent), the disease becomes chronic. With chronic inflammation, complications gradually develop, including heart failure, cardiomegaly, and cardiosclerosis.
The process of diagnosis and examination of the child helps the doctor to find out the form of the disease, its causes, as well as the stage of development - only after receiving these data can a truly effective treatment regimen be drawn up.
Symptoms of illness in a newborn
Signs of an illness depend on many factors - here it is worth taking into account the age of the child, the origin and form of the disease. Myocarditis is most severe in newborns. The baby slowly gains weight, becomes drowsy and inactive, as even the process of feeding is very tiring for him. The baby's skin is pale, often becoming gray.
Another symptom is shortness of breath. First, it appears during periods of activity - the baby breathes quickly and heavily while changing clothes, bathing, defecation, feeding. As the disease progresses, breathing difficulties can be observed even at rest. Due to developing heart failure, edema appears - sometimes they are very pronounced, due to which the weight of the baby increases dramatically. Examination of the child reveals an enlarged liver and spleen.
Features of the clinical picture in a child older than two years
In older children, the clinical picture looks different. Within 2-3 weeks after the primary infection, myocarditis does not appear at all. Then the symptoms become more pronounced. Signs of illness include:
- pallor of the skin;
- fatigue, weakness, slight fever;
- disappearance of appetite and, accordingly, weight loss;
- pain in the muscles and joints, and sometimes in the abdomen;
- as the disease develops, children begin to complain of pain in the heart area;
- shortness of breath and palpitations appear.
Myocarditis: diagnosis of the disease
With such a disease, correct diagnosis is of great importance. With a child, it is best to contact the children's cardiology center. The following procedures are required to make a diagnosis:
- To begin with, a survey of the child and parents is carried out to make an anamnesis,determine the presence of certain symptoms.
- Already during the examination, the doctor may suspect myocarditis - the specialist observes pallor, even cyanosis of the skin, palpitations, edema and shortness of breath.
- A biochemical and serological blood test is carried out, which allows you to determine the presence of an infection and an inflammatory process.
- Chest X-ray allows a specialist to see the expansion of the boundaries of the heart and the presence of stagnation of blood in the vessels of the lungs, which confirms the presence of an inflammatory process in the myocardium.
- Electrocardiography and echocardiography are mandatory - such procedures make it possible to examine the work of the heart and assess the degree of violations.
- Myocardial biopsy is indicated only in the most severe cases, as it helps to determine the extent of the inflammatory process.
Treatment of the disease: what do doctors offer?
Of course, therapy depends on the cause and degree of development of the disease. For example, in the presence of a bacterial infection, antibiotics are needed, and in case of viral lesions, antiviral drugs are indicated. Also, children are prescribed immunomodulators, which allow normalizing the work of protective mechanisms.
To eliminate the inflammatory process, patients take anti-inflammatory nonsteroidal drugs (Voltaren, Brufen, Indomethacin). In especially severe cases, steroid hormonal drugs are used, which are more effective in combating inflammation. Used to eliminate edemadiuretic drugs to get rid of excess fluid. It is also important to include vitamin preparations in the therapy regimen. If we are talking about a chronic process, then sanatorium treatment is indicated. If there is a persistent arrhythmia that does not respond to medical treatment, a pacemaker may be needed.
Treatment is carried out in a hospital, it is advisable to choose a good children's cardiology center with good specialists. At the end of the course of therapy, the child should still undergo regular examinations - first every few months, and then twice a year (with a favorable course of the disease). Echo and electrocardiography, chest X-ray, blood tests should be done periodically - this is the only way to notice a relapse or the presence of complications in time.
Diet for a child with myocarditis
Many parents today are interested in questions about why it develops and what constitutes myocarditis in a child. Symptoms and treatment of the disease, its causes are, of course, important points. But it is worth considering that during therapy, the child needs a special diet (if it is not a baby).
Experts recommend giving up simple carbohydrates - you should not give your child muffins, chocolate, white bread, pasta. You can replace them with baking without yeast. Also, do not abuse s alty and spicy foods, fatty meats and fish, rich soups and broths - it is better to eat low-fat chicken fillet and liver (by the way, it is advisable to cook steamed dishes). Fish is allowed, but only if we are talking about low-fat varieties. The number of eggs should also be limited.
The diet should include fermented milk products, fresh fruits and vegetables (except plums, quince, hard pears and apples, grapes). Chocolate and other sweets can be replaced with honey, jam, marshmallows and marmalade.
Prognosis for myocarditis
Myocarditis in a child is especially dangerous in the first months of life - it is in this age group of patients that death is most often observed. Forecasts depend on the form and severity of the disease. For example, a mild form of the disease sometimes does not require treatment at all. Bacterial inflammation is easier to treat, but with a viral lesion, the outcome of the disease may not be too good.
Among school-age children and adolescents, adverse events are rarely recorded - as a rule, children recover quickly enough and return to normal life. True, sometimes during myocarditis, sclerotic areas form in the heart, which can cause the development of heart failure in adulthood.
Prophylaxis
Unfortunately, there is no universal remedy for myocarditis. Nevertheless, experts recommend following some rules. A pregnant woman should be attentive to her he alth, prevent the development of infectious diseases, avoid contact with toxins, and be tested regularly.
The condition of the newborn should be carefully monitored - infectious and inflammatory diseases should be diagnosed and treated in time. During outbreakscolds, if possible, do not allow the child to come into contact with infected people. Proper nutrition, a clear daily routine, moderate physical activity and hardening will positively affect the state of the immune system.
