Myocarditis - Symptoms And Treatment Of Myocarditis

2024 Author: Josephine Shorter | [email protected]. Last modified: 2024-01-07 17:49

Symptoms and treatment of myocarditis

Myocarditis is inflammation of the heart muscle (myocardium). The disease can occur as a result of exposure to infectious agents, toxins and as an allergic or autoimmune reaction. Inflammation of the myocardium can be both a symptom of various diseases, and an independent disease. It often occurs due to rheumatism, one of the manifestations of which is along with pericarditis and endocarditis. Myocarditis is acute and chronic; the acute form often transforms into cardiomyopathy.

Pathology is characterized by various symptoms that can manifest themselves brightly or have a latent course. Diagnosis of the disease is not difficult only when, after a viral infection, the patient shows signs of an acute malfunction of the heart. With an erased clinical picture, it can be quite problematic to make a correct diagnosis.

Recently, the disease affects young, able-bodied people (30–40 years old). Myocarditis leads to a decrease in pumping function, impaired circulation, heart rate and conduction. This entails serious consequences: disability and even death.

Content:

• Myocarditis of the heart - what is it?
• Myocarditis reasons
• Myocarditis symptoms
• Types of myocarditis
• Complications of myocarditis
• Diagnosis of myocarditis
• Myocarditis treatment

Myocarditis of the heart - what is it?

Myocarditis is an active process of inflammation in the myocardium, in which there is necrosis and degeneration of cardiomyocytes (muscle cells of the heart). In this case, the pathological changes occurring in the heart with myocarditis differ from the changes that occur during a heart attack. Cardiomyocytes die and undergo the process of fibrosis. The appearance of inflammatory infiltrates can be provoked by any immune cells, but the cause of this inflammation is most often an external factor.

As for the statistics of myocarditis, it is rather difficult to designate specific numbers. The fact is that the disease often runs latently and is not diagnosed by doctors. Long-term chronic inflammation leads to the development of dilated cardiomyopathy in a person. Moreover, this happens many years after the impact of the etiological factor that gave rise to myocarditis.

Routine autopsy reveals myocarditis in only 1-4% of cases. As for European countries and North America, viral infections are considered to be the leading cause of myocarditis. The defeat of the heart muscle occurs, according to various sources, in 5% of cases after all viral infections. In this case, pronounced cardiac pathology will be observed in 0.5-5.0% of cases.

An increase in the risk of developing myocarditis is additionally influenced by factors such as carrying a child, a person's age (most often myocarditis develops in infants and adolescents), as well as the season.

The mechanism of development of the disease is currently being actively studied. Scientists believe that viruses affect the antigens sent by cardiomyocytes, as a result, it is their immune cells that are perceived as foreign and begin to destroy. Thus, an immune cellular response develops.

More often than others, enteroviruses, influenza viruses, Coxsackie A and B viruses lead to myocarditis. From 25 to 40% of HIV-positive people have signs of a malfunction in the heart, and only 10% show any symptoms.

There is more and more evidence that myocarditis can develop after a long time after radiation therapy and acts as a distant complication of it. In this case, the arteries and valves of the heart, as well as the myocardium itself, can be damaged even many years after irradiation. Therefore, modern radiation therapy, taking into account this fact, should be carried out in such a way that a person can avoid such distant heart problems.

Myocarditis reasons

Various acute viral infections and bacteria can be the reasons for the development of myocarditis. Influenza, measles and rubella, chickenpox, diphtheria, scarlet fever, pneumonia, sepsis, etc. contribute to its occurrence. It is viruses that are the most common cause of this pathology. It has been proven that during viral epidemics, the incidence of myocarditis increases sharply. It is noteworthy that two or more different infections can act as the cause of myocarditis. One of them, most often, is a condition of damage to the heart muscle, and the second is its immediate cause.

In addition to infection, myocarditis can be caused by poisoning and disorders of the immune system (including with the introduction of serums and taking certain medications). The etiology of some myocarditis (idiopathic myocarditis of Abramov-Fiedler) has not yet been established.

Physical activity is not recommended for people with myocarditis, as they can aggravate the disease.

Myocarditis symptoms

The symptoms of myocarditis depend on how damaged the myocardium is, where the inflammatory process is located, how acute it is and how quickly it progresses. In any case, the contractile function of the heart muscle suffers, there are cardiac arrhythmias. If the provoking factor is an infection or allergy, then myocarditis manifests itself immediately after the illness. Rheumatic myocarditis has a different symptomatology. The latent course of the disease is not excluded.

Symptoms of viral and infectious-toxic myocarditis are manifested with severe intoxication; with infectious-allergic myocarditis, signs of myocardial inflammation appear a couple of weeks after an exacerbation of a chronic disease; in case of poisoning (serum and drug myocarditis), the lesion appears 12–48 hours after serum administration or medication.

Infectious-toxic myocarditis is most often preceded by a prodromal phase with flu-like symptoms. Skin rashes and soreness in the muscles and joints are possible. For children, the Coxsackie virus is especially dangerous.

Sometimes myocarditis does not have pronounced clinical manifestations and can be detected only after an ECG examination.

The common symptoms of myocarditis are:

• Increased fatigue;
• Unreasonable weakness;
• Shortness of breath, worse with physical exertion. Although sometimes she appears at rest;
• There may be a cough and a feeling of heaviness in the right hypochondrium;
• For severe myocarditis, edema in the legs and a decrease in the volume of urine excreted are characteristic;
• Pain in the region of the heart. They can proceed as seizures, or they can be aching in nature. Most often, they bother a person for a long time and are not associated with physical activity;
• An increased heartbeat or its work intermittently - these symptoms indicate existing heart rhythm disturbances. Patients complain that they experience a feeling of fading or cardiac arrest;
• Body temperature remains within normal limits, although it is possible that it will increase to subfebrile levels;
• The person often suffers from excessive sweating;
• Sometimes there are painful sensations in the joints;
• Blood pressure is most often below normal;
• The skin is pale and often bluish in color. This is especially noticeable on the tips of the fingers, on the earlobes, on the tip of the nose;
• As for the pulse, it can be either increased or slowed down;
• Dilated cervical veins indicate severe heart failure.

The heart is enlarged, even small foci of infiltration in the organ can provoke the development of arrhythmias and lead to the death of the patient. Despite the fact that there are many symptoms of myocarditis, often only 1-2 of them appear, and in 1/3 of patients there are no signs of cardiac pathology at all.

There are such variants of the course of myocarditis as acute myocarditis of severe and mild course, recurrent myocarditis and chronic myocarditis.

Types of myocarditis

Myocarditis can differ in etiology, clinical manifestations and consequences:

• Bacterial myocarditis is quite rare and is caused mainly by the bacilli of Staphylococcus aureus or Enterococcus. This form of the disease affects the valve rings and the interventricular septa. Bacterial myocarditis also occurs with diphtheria (in 25% of patients), being its most serious complication and a frequent cause of death. With diphtheria, a specific toxin is produced that prevents protein synthesis. It is he who promotes expansion, flabbiness of the heart, worsens its contractility. Patients are prescribed antitoxins and antibiotics;
• Chagas disease develops due to the simplest organisms - trypanosomes. In this case, extensive myocarditis occurs, which usually manifests itself several years after infection. The disease has a predominantly chronic course, exacerbation can occur only in extremely rare cases. The disease is characterized by progressive heart failure and arrhythmias; it is they who, in the absence of adequate therapy, lead to death;
• Toxoplasma myocarditis is a rare form of heart muscle damage and occurs most often in young people with weak immune systems. The disease is characterized by heart failure, arrhythmia, conduction disturbances;
• Giant cell myocarditis has an unexplained origin. In this form, multinucleated giant cells are found in the heart muscle, causing rapidly progressive fatal heart failure. This myocarditis is rarely diagnosed, it develops in adults and often proceeds together with diseases such as thymoma, systemic lupus erythematosus, thyrotoxicosis;
• Lyme disease is a disease caused by tick-borne relapsing fever. Its typical symptom is cardiac conduction disturbances. Often this form is accompanied by pericarditis and malfunctions of the left ventricle;
• Radiation myocarditis occurs due to ionizing radiation. It leads to a variety of acute (less often) and chronic (mainly) heart disorders. Together with this form of myocarditis, myocardial fibrosis often develops.

Complications of myocarditis

Complications of myocarditis are manifested in sclerotic lesions of the heart muscle, resulting in the development of myocardial cardiosclerosis.

Acute myocarditis in severe form very quickly leads to the formation of heart failure and arrhythmias in the patient. This, in turn, often provokes sudden death of a person.

Diagnosis of myocarditis

Diagnosis of myocarditis causes certain difficulties. They are caused not only by the latent course of the disease, but also by the lack of clear criteria for the detection of pathology among doctors.

The main activities that are carried out in order to detect the disease are as follows:

• Clarification of the patient's complaints;
• Carrying out physical diagnostics, during which it is possible to detect various heart disorders, ranging from tachycardia to heart failure. In addition, the patient may have edema of the extremities, an increase in the cervical veins, congestion in the pulmonary system, etc.;
• Conducting an ECG, according to the results of which it is possible to judge about the violation of the heart rhythm, conduction and excitability of the heart. At the same time, it will not be possible to detect any signs specific to myocarditis with the help of an ECG;
• Echocardiography. This technique will detect such pathologies of the heart muscle as an increase in its cavities, low contractility and diastolic dysfunction;
• Radiography of the lungs allows you to diagnose the presence of congestion in the respiratory organs, and also makes it possible to determine the size of the heart;
• To identify the type of pathogen that led to the development of myocarditis, a BAC blood culture can be carried out or it can be taken for PCR;
• MRI of the heart using a contrast agent allows you to see the process of inflammation, to detect edema in the heart muscle. This is a fairly informative method that produces results 75% of the time;
• The introduction of a catheter into the heart cavity for taking a biopsy of the myocardium for the purpose of its subsequent histological examination makes it possible to determine myocarditis only in 37% of cases. This is due to the fact that the focus of inflammation can be concentrated anywhere in the heart muscle, and not where the biopsy sample was taken from;
• The area of necrosis and inflammation can be determined by radioisotope examination of the heart (PET-CT).

Myocarditis treatment

Treatment of myocarditis, regardless of the cause that provoked it, generally has similar elements. This is due to the fact that in any myocarditis, inflammation of the heart muscle occurs and an inadequate response of the immune system to inflammation is observed, which leads to the death of cardiomyocytes and the development of myocardial cardiosclerosis. The listed set of factors determines the tactics of therapy.

Treatment in a hospital can last from 3 weeks to 2 months, depending on the patient's state of health.

At this time, it is necessary to realize three global goals:

• Carry out medical correction;
• Eliminate foci of chronic infection;
• Start the patient's physical rehabilitation.

As for the drug treatment of myocarditis, it involves the appointment of anti-inflammatory drugs and drugs that affect the cause that led to the development of the disease (etiotropic therapy). In addition, the administration of antihistamines, antiplatelet agents, agents that reduce the activity of the sympathoadrenal and renin-angiotensin-aldosterone systems are shown.

This also includes the reception of immunocorrectors, means for the normalization of metabolic processes.

Since an infection becomes the basis for the development of myocarditis, then already by the severity of inflammation, one can suspect that bacteria or viruses provoked cardiac disorders. So, with the bacterial nature of myocarditis, the inflammation is more acute, but at the same time it lends itself well to correction with antibacterial drugs. In addition, bacteria are less likely to lead to chronic inflammation in the myocardium.

If it is established that myocarditis is of bacterial nature, then the patient is prescribed a course of antibiotics. The most preferred are drugs from the cephalosporin group. When the disease has acquired a chronic course, repeated courses of antibiotic therapy using drugs from the group of fluoroquinolones and macrolides are indicated. Their reception is necessarily supplemented with exogenous interferons and inducers of endogenous interferon (Viferon, Neovir). Exogenous interferon preparations are especially effective in combating viral myocarditis.

Antihistamines and anti-inflammatory drugs are prescribed to relieve inflammation in the heart muscle itself. To do this, the patient takes a short course of NSAIDs (Diclofenac, Metindol, etc.), as well as anti-allergenic drugs - Tavegil and Suprastin. For up to six months, patients are recommended to take Delagil.

The next stage of treatment is therapy with steroid hormones (Dexamethasone and Prednisolone). However, these drugs are not indicated for all patients, but only for those in whom the autoimmune factor prevails in the inflammatory process. Prednisolone is prescribed in short courses. Pulse therapy with this hormone with its intravenous administration is preferred. Although oral administration for a week is not excluded, followed by cancellation within thirty days. At the same time, in most patients, there is an improvement in the condition with the disappearance of edema, stabilization of the heart rate. However, treatment with steroid hormones is always associated with certain complications, which must be kept in mind by the doctor.

So, patients have an increased risk of contracting other infections, because the immune system refuses in a depressed state. Any ARVI can provoke a recurrence of myocarditis. Therefore, if a viral infection led to the pathology of the heart muscle, then antiviral therapy is necessary before starting treatment with hormonal drugs.

From the very first days after the diagnosis, patients are prescribed antiplatelet drugs (Trental, Aspirin-Cardio, etc.) that thin the blood. It is caused by circulatory problems caused by fibrosis of the heart muscle tissue. ACE inhibitors and interferon antagonists allow to slow down the process of myocardial fibrosis.

Since the occurrence of cross-over autoimmune processes in myocarditis is almost a regularity, patients are shown immunocorrective therapy. For this, courses of plasmapheresis, repeated courses of pulse therapy of glucocorticoids and interferon inducers are prescribed.

With regard to the normalization of metabolism, it is important to carry out metabolic correction before starting antibacterial or antiviral therapy. In addition, throughout the treatment, the patient must adhere to strict bed rest. Potassium preparations (Asparkam, Potassium orotat, Panangin), Riboxin, ATP are prescribed.

Symptomatic therapy depends on the severity of the clinical picture of the disease. So, to reduce edema, diuretics are prescribed, etc.

While in the hospital, the patient must be relieved of foci of chronic infection. Sinusitis, tonsillitis, pulpitis, etc. are treated. It is important to choose the optimal time for the treatment of these diseases so that the patient's general well-being does not deteriorate during therapy.

After discharge, the patient needs rehabilitation measures. They can take place either in a sanatorium or at a district clinic. Treatment with Delagil and antiplatelet drugs continues. Be sure to appoint aldosterone antagonists, ACE inhibitors, B-blocker antagonists.

The diet involves limiting salt and fluid during the acute period of the disease. The emphasis is on protein foods with the maximum intake of vitamins. The duration of therapy depends on the severity of the disease and ranges from six months or more.

If myocarditis had a latent course, then an independent cure without the development of long-term complications is possible. If the patient develops heart failure, then the treatment is effective only in 50% of cases. In another 25% of patients, cardiac activity can be stabilized. In the rest of the patients, heart failure continues to progress.

The author of the article: Molchanov Sergey Nikolaevich | Cardiologist

Education: Diploma in "Cardiology" received at the PMGMU. I. M. Sechenov (2015). Here I completed my postgraduate studies and received a diploma "Cardiologist".