Myocarditis in children

Myocarditis in children can be observed in virtually all infectious diseases. Especially often - rheumatism, diphtheria, scarlet fever, typhoid infection. Myocarditis bacterial, viral and toxic origin are most often found in children of early age. For older children is more common myocarditis, developing against the background of infectious and allergic diseases.
Pathomorphological myocarditis in children, except necrosis muscle fibers, are characterized by severe exudative reaction.
The clinical picture of myocarditis in children differ by the severity and rapidity of increase of symptoms. The disease often manifested by fever. The child marked shortness of breath, pallor of skin in combination with acrocyanosis (cyanosis distal extremities), weakness, dry, painful cough, and older children, in addition, headache, insomnia, unpleasant feelings in the heart area. An objective examination are increasing borders cardiac dullness, tachycardia, a rhythm disturbance of the heart. In the result of the stagnant phenomena in small and large circle circulation appear wet congestive wheezing in his lungs, increased liver. Chest x-ray are extended and slightly pulsating heart, extended the roots of the lungs. When myocarditis in children often violated functions of the gastrointestinal tract (violation of processes of digestion and absorption) and the Central nervous system, fatigue, dizziness and other).
The prognosis of the disease if detected early and correctly therapy favorable. With the exception of myocarditis in newborns and children of early age, which give a high percentage of mortality.
Treatment of myocarditis in children spend in hospital. Appointed first of all antibiotics in the age dosages, b vitamins, ascorbic acid. Good effect has phosphorylated vitamin B1 -kokarboksilaza dose of 50-100 mg / day intravenously or intramuscularly. When there are pronounced edema apply discharge (fruit sugar) diet, diuretics (gipotiazid 1 mg/kg / day orally, lasix 1 to 2 mg/kg and others). When revmocardit (see Rheumatism) shown salicylates (acetylsalicylic acid 0.2 g per year of life per day) and preparations pirazolonovogo series (amidopyrine 0.15 g on 1 year of life per day). In the therapy of myocarditis in children begin to be widely used hormonal preparations (prednisolone of 0.8-1 mg per 1 kg of weight per day in the morning hours). When there are events decompensation after remitting acute inflammatory process in the heart muscle prescribed drugs naperstanki. When the sleep disturbance, restlessness, headaches shown symptomatic therapy.

Acute myocarditis in children occur in any mostly early age. Described acute Meters in newborns.
Etiology M in children is different. More often etiological factor is a viral infection caused by the Coxsackie virus, polio, measles, chickenpox, influenza, mononucleosis, fever), then listeriosis, toxoplasmosis, rheumatic fever, diphtheria, coccal flora of pneumonia, sepsis. In those cases, when to identify the etiology M unable, it is called "idiopathic", "insulated", "allergic".
Before the emergence of M. history of sick children often reference respiratory viral disease that is sometimes accompanied by diarrhea. Since the initial infection to clinical manifestations of the disease of the heart takes several days or weeks. Some children Meters occurs after vaccination (against smallpox, diphtheria), the introduction of gamma globulin. In newborns described intrauterine M, caused by Coxsackie virus Century virus Infection occurs in utero through the placenta. Such Meters, especially in neonates, accompanied by brain damage (entsefalomiokardita) and liver (entsefalomiokardita).
M children often begins acutely and immediately hard. The severity of the condition is caused by fast development of symptoms of heart and some patients with cardiovascular failure. The child at normal or elevated temperatures appear anxiety, pale face, shortness of breath, a dry cough, often vomiting, refusal to eat, sometimes diarrhea. Infants prolonged scream, rushing about in bed, not sleeping. The disease in some cases begins with the collapse of the appearance of cold sweat, short-term loss of consciousness, rarely convulsions. In infants M often begins with shortness of breath. In children older than 2 years, the first complaints can be sharp abdominal pain. With the gradual beginning of myocarditis marked lethargy, malaise, pallor of the face, poor sleep, cough and, later, vomiting, pastoznost face, swelling in the legs, ascites. At objective inspection, in addition to anxiety, sudden pallor of the face, lips cyanosis and nails, for children above, there has been a forced position: they prefer to sit due to sudden shortness of breath (from 60 to 100 breaths in 1 min). There are moaning breath and dry cough. Above the light sound box, with frequent accession effusion pleural cavity percussion shortened, respiration is weakened. Some patients are heard single dry and moist rales stagnant nature.
In the study of the heart there is the expansion of the boundaries in all directions, with a sharp toxicity and swelling of the lungs true boundaries of the heart are difficult to determine. The muted tones, heard and weak systolic murmur at the top, tachycardia (140-200 beats per 1 min), less arrhythmia (gallop rhythm, arrythmia, fibrillation, of atrioventricular blockade imbricate). Pulse soft; acrocyanosis, cooling of the extremities. Blood pressure is lowered. The liver is enlarged, stands out from under a rib edge of 5-10 cm, some determined ascites. Stool often normal. In rare cases there is a momentary loss of consciousness and seizures.

When x-rays of the chest revealed a large spherical heart. The heartbeat of surface and not too rapid. ECG voltage peaks reduced the segment S - T offset, there is the inversion of the T wave, sometimes longer interval P-Q, and the widening of the QRS complex. In blood moderate anemia, leukocytosis without left-shift, ROE normal or slightly accelerated. In urine traces of protein, single leukocytes and erythrocytes.
For M can be lightning fast, acute, sub-acute, protracted and chronic. The lower the age of the child, the more current. The literature describes the cases of recovery from M viral etiology, but more often the disease ends lethally.
The cause of death is acute cardiac insufficiency, collapse, thrombosis and embolism.
Myocarditis should be differentiated with diseases in which there is cardiomegaly and heart disease - congenital fibroblasts and heart defects, defect of the left coronary artery with a discharge her from the pulmonary artery syndrome Ayers, pericarditis, Nowotny nodosa with the defeat of coronary vessels, glycogenic heart disease, gipovitaminoz B1; gipokaliemia.
Treatment: strict bed rest with elevated position of the chest, at rest. Oxygen therapy. Diet suitable for the age of the child, with a large number of vitamins (C-200 mg per day, B1 and nicotinic acid up to 20 mg). At hypostases - salt-free diet. Digitalis appointed as in heart failure (see Circulation, circulatory insufficiency). Treatment with digitalis are under the control of ECG. Hormone therapy is prescribed for 1-1,5 months. Prednisolone is used at a dose of 1 mg per 1 kg of body weight per day in 2 admission, the dose after 2 weeks gradually diminish. During treatment with hormones child designate potassium buffet or potassium chloride. Hydrocortisone is prescribed in doses of 5 mg per 1 kg of weight per day, followed by a gradual reduction of the dose.
When edema is used diuretics within 1-3 days. Gipotiazid 0,005-0,01 g per day, 2 times a day, depending on age. Novoryt 0.1 ml of 1 year of life intramuscularly in 1-2 days. Favorit interior of 0.01-0.02 g 1 time per day through the day, only 2-3 times.
With a sharp concern is injected under the skin 1% solution of morphine 0.25-0.5 ml for children up to 1 year over year - 0.5-1.0 ml 1-2 times a day.