Myocarditis

Myocarditis is an inflammation of the myocardium. Most myocarditis often occurs in infectious diseases (rheumatism, diphtheria, abdominal and typhus, typhoid, sore throat, scarlet fever, sepsis, severe flu and other). Myocarditis is and allergic nature (due to the high sensitivity of the myocardium to the impacts of the decay products of microbial bodies, certain medications, and others). Myocarditis pathological changes can be localized primarily in muscle fibers (parenchymal myocarditis) or in interstitial tissue (interstitial myocarditis). The prevalence of lesions may be diffuse or focal.
Myocarditis may be hidden, but most patients complain of pain in the region of heart intermissions, palpitation, shortness of breath and weakness. All these phenomena is greatly enhanced by physical strain. When viewed note paleness of skin, sometimes with a bluish tinge. The pulse is small, soft, rapid, less often slow; frequent disturbances of rhythm and conduction (see heart Arrhythmia). The heart is enlarged, the colours weakened, often heard systolic murmur at the apex; sometimes gallop rhythm (see Gallop rhythm), indicating severe damage to the heart muscle. Using ECG find diffuse changes of the myocardium, slowing conduction (lengthening of the interval R - On, incomplete or complete AV blockade). The increased body temperature, changes in blood are not specific to myocarditis and is usually caused by a disease causing myocarditis (rheumatism, typhoid and others).
Downstream myocarditis may be acute or chronic. Acute myocarditis often develop severe blood circulation disorders: dyspnea, cyanosis, swelling of the neck veins, enlarged liver, swelling of the legs, dropsy cavity (ascites, hydrothorax). Sometimes there is a tendency to fainting. There may come a sudden death due to cardiac arrest. In some cases, the clinical picture is dominated by the symptoms of cardiovascular insufficiency: pale skin, low blood pressure, frequent, small pulsethat depends on disorders of the vascular tone regulation that is observed in many infectious diseases.
Chronic myocarditis is rare, mainly tuberculosis, syphilis and rheumatism. Disorders of the myocardium with syphilis and tuberculosis postmortem similar defeats of other organs in these diseases, such as hummocky myocarditis with syphilis.
Clinical presentation and course of myocarditis have the features and depending on the etiology of the disease. Rheumatic myocarditis pathological changes of focal character are concentrated in the interstitial tissue. I often marvel at the endocardium, and pericardium (see Rheumatism). Characterized by pain in the heart, violations of rhythm and conduction; in severe M. cardio-vascular insufficiency. Diphtheria myocarditis usually develops in the second week of the underlying disease. Postmortem is diffuse parenchymal myocarditis. Characterized by severe heart failure and disorder conductivity up to complete atrioventricular block. Bruchkomitsky myocarditis develops in 3-4 weeks from the beginning of typhoid fever, and sometimes in the recovery period. Severe heart failure, as a rule, does not occur, but often develops vascular insufficiency due to the influence of bruchkomitsky infection centers of vascular regulation.
Particularly severe course differs isolated idiopathic malignant myocarditis (myocarditis Abramov - Fiedler). The etiology and pathogenesis of this myocarditis unclear. Clinically, it is severe heart failure, pain in the heart, disorder of heart rhythm; there is often a fever. This myocarditis often complicated by tromboamboliy in large and small circulation. Proceeds acute and subacute, less often chronically.
Diagnosis of myocarditis is not difficult, if symptoms of heart disease has arisen on a background of any infectious disease or intoxication.
Forecast myocarditis always serious. Acute myocarditis occurred on the background of infectious disease, usually ends with a recovery with the development of more or less expressed cardiosclerosis (see). Very heavy forecast myocarditis Abramov - Fiedler, death rate at which high.
Treatment of patients with acute Meters out in a hospital. Drug treatment in the first place should be aimed at elimination of the disease, causing myocarditis (rheumatic fever, diphtheria, sepsis and other). To suppress allergic mechanism in the development of myocarditis in some cases, the use of corticosteroid hormones (prednisolone). When heart failure is shown cardiac glycosides, better intravenous enter strofantin 0.05% solution 0.5 ml or korglykonum 0,06% solution of 1 ml in 20 ml of 40% glucose solution or izotoniceski solution of sodium chloride 1-2 times a day; the use of digitalis (see) myocarditis less effective. Swelling prescribe diuretics. Circulatory collapse shows the use of means increasing the tone of vessels: kordiamin 2 ml subcutaneously, caffeine-benzoate sodium 1 ml of 10% solution subcutaneously, camphor 2 ml of the 20% oil solution subcutaneously, mezaton 0.5-1 ml of 1% solution subcutaneously, ephedrine 0.5-1 ml of 5% solution subcutaneously and others In severe cases, intravenous drip impose 400-800 ml izotoniceski solution of sodium chloride or 5% glucose solution. According to the indications in the liquid add norepinephrine or adrenaline, hydrocortisone or prednisolone (see the blood Circulation, circulatory insufficiency). Myocarditis is appropriate to assign a means improving a metabolism in the myocardium,vitamins, kocarboksilazu, ATP. In severe acute myocarditis with pronounced symptoms of heart failure prescribe bed rest with a limit of active movements of the patient in bed, sometimes for several weeks. Food should be easily digestible, rich in vitamins, but not cause of bloating. Prescribed mainly dairy and vegetable dishes, boiled meat and cooked fish; restrict fluids and salt, especially when heart failure.
Physical therapy in severe myocarditis designate very carefully, after the disappearance of symptoms of heart failure (swelling, shortness of breath at rest). Start with breathing exercises and exercises for small and medium groups of muscles of the hands and feet (turns the hands, palms up with unclamping fingers, alternate bending and straightening of the feet, hands in the elbow joints, alternating bending the legs, keeping the feet from the bed). Exercises are conducted in a prone position with a raised body and head, at a slow pace. Then add exercise for the body (lifting of the pelvis, turns on its side). With good endurance exercise therapy volume of gymnastic exercises gradually expand. If myocarditis proceeds of netzero, exercise therapy appoint from the first day of a hospital stay.
Prevention. It is necessary to prevent diseases that cause myocarditis, and timely and effective manner to treat them.


Myocarditis (myocarditis; from the Greek. mys, myos - muscle and kardia - the heart - is an inflammation of the heart muscle.
Infectious diseases are often accompanied by functional changes in the myocardium, detected clinically or electrocardiographically. Although the material substratum constitutes the basis of all disorders of the myocardium, however, it is not always expressed in a visible change in the structure of the fabric, and disorders of the myocardium often depend on subtle biochemical and biophysical changes of the myocardium.
M. common in people of all ages, both men and women. To divide M by various forms is the most expedient not by morphological, and etiological principle. There are myocarditis: 1) fetal (the existence of which is still disputed); 2) in relation to communicable disease (bacterial, viral, fungal, parasitic and other) [(a) with endocarditis and b) without endocarditis]; 3) separate diffuse [(a) due to the high sensitivity and b) from an unknown cause] or granulomatous; 4) specific (rheumatic, tuberculosis, syphilis).
Every infectious disease, whatever the pathogen is not called (microbe, virus and other)might be complicated M.