The human heart is an organ that pumps blood throughout the body through the circulatory system. It supplies tissues with oxygen and nutrients, and also removes carbon dioxide and other waste. These processes occur by contracting the heart muscle and relaxing as the heart fills with blood.
Inflammation of the heart muscle (myocarditis, inflammation of the myocardium) is a condition caused by a reaction to internal or external factors, such as infections caused by bacteria or the virus. Some inflammatory processes occur when the human immune system mistakenly believes that the organs of his body are foreign. Sometimes inflammation can lead to tissue scarring, cardiomyopathy (myocardial damage), or arrhythmia (heart rhythm disturbance).
Causes
Myocarditis is a fairly rare disease. And often the exact causes of its occurrence may not be known. Most often, the disease occurs against a background of infections. They can be, for example, mycoplasmosis, chlamydia or Lyme disease. As the patient worsens, the ability of the heart to pump blood is impaired. This leads to a decrease in blood supply to all organs. Ultimately, the strength of the contractions of the heart decreases and the ability to supply blood to the body deteriorates.
The causes of inflammation of the heart muscle are divided into infectious and non-infectious. Infectious diseases include:
- viruses (coxsackie virus, influenza, herpes, HIV, parovirus, hepatitis C, cytomegalovirus, measles, polio, chicken pox, rubella, rabies);
- bacteria (streptococcus, staphylococcus, tuberculosis);
- spirochetes (syphilis, Lyme disease);
- fungus (candidiasis, histoplasmosis, aspergillosis);
- protozoal infections ( Chaga disease , toxoplasmosis, schistomiasis).
Non-infectious causes of inflammation of the heart muscle can be:
- Hypersensitivity to certain antibiotics, chemotherapy drugs, for example, Doxorubicin, Zidovudine, Dobutamine, Cytoxan.
- Toxins - anthracyclines, drugs (cocaine, methamphetamine), alcohol, heavy metals (lead, arsenic, carbon monoxide), radiation, certain chemicals, poisons, etc.
- Systemic diseases - sarcoidosis, collagen vascular diseases, Wegener's disease, thyrotoxicosis, hypereosinophilic syndrome, celiac disease, acute rheumatic fever, lupus.
- Idiopathic (not established) etiology.
The most common cause of heart muscle inflammation in a child or adult is a viral infection, such as the flu or a cold. The virus itself can penetrate the heart and damage the muscle. Cells in the body's immune system can also damage the heart muscle as they fight infection.
Symptoms
Signs of inflammation of the heart muscle depend on the cause and severity of the course of the disease. For example, many people with myocarditis due to the Coxsackie virus do not have any symptoms of the disease. The only indicator of inflammation of the heart muscle may be a temporary abnormal result on an electrocardiogram (ECG) - a test that measures the electrical activity of the heart. Or during echocardiography (ultrasound of the heart), some changes can be detected, for example, reduced contractile activity of the myocardium.
Typical symptoms of heart muscle inflammation include chest pain and arrhythmias that occur during or shortly after an infectious disease. In most cases, myocardial damage is weak, quickly and completely heals, and does not affect the pumping function of the heart. However, inflammation of the heart muscle can sometimes cause extensive damage, leading to myocardial failure. This life-threatening condition requires quick care in a specialized institution. Fortunately, this condition is quite rare.
Common symptoms of heart muscle inflammation in adults include:
- chest pain;
- arrhythmia (abnormally fast, slow, or irregular heartbeat);
- sudden loss of consciousness (fainting);
- temperature rise;
- joint pain and swelling;
- signs of heart failure (shortness of breath, leg swelling);
- fatigue.
In a child with myocarditis, the following symptoms may appear:
- temperature rise;
- tachycardia or arrhythmia;
- rapid breathing;
- difficulty breathing, especially when moving;
- the appearance of anxiety or irritability;
- bad sleep;
- refusal of food;
- excessive sweating;
- weakness, lethargy, apathy, fainting;
- rare urination;
- pale integument of arms, legs (cyanosis);
- vomiting
Older children may complain of the following ailments:
- cough;
- nausea
- pain in the abdomen or chest;
- swelling in the legs, feet, and face;
- shortness of breath or trouble breathing at rest, at night;
- weight gain.
Establishing diagnosis
Diagnosing heart muscle inflammation is often quite difficult. This is due to the fact that the symptoms of myocarditis are similar to signs of other diseases of the heart, lungs, or flu.
To make a diagnosis, a specialist collects an anamnesis. The doctor interviews the patient and receives detailed information about any symptoms, chronic diseases and infections. Then an examination is carried out. When listening to the heart with a stethoscope, a specialist can detect a rhythm disturbance. During a physical examination of the patient, external manifestations of myocarditis can be detected, for example, swelling of the limbs, swelling of the joints or pallor of the skin.
In addition, additional research may be needed. They will give more complete information about the state of the heart and how well it works. Such examinations may include:
- A chest x-ray is a snapshot of the heart and lungs that captures the blood vessels, ribs, and bones of the spine.
- Echocardiography. During this test, sound waves are used to evaluate the function and structure of the heart muscle and valves.
- An electrocardiogram is a test that records the electrical activity of the heart.
- MRI (magnetic resonance imaging) is a non-invasive procedure in which, using radiation, a detailed image of the structure and functions of the heart is obtained during its operation.
- A heart biopsy is a procedure for obtaining a sample of heart muscle tissue in order to check for signs of infection and inflammation. The material is obtained by cardiac catheterization, in which a long thin tube (catheter) is inserted into an artery or vein in the groin, arm or neck.
- Blood tests for infections, liver and kidney function tests to find antibodies against viruses.
Treatment
How to treat inflammation of the heart muscle? First of all, the choice of therapy depends on the cause and severity of the disease. Possible options include basic pharmacological treatment of ventricular dysfunction, the installation of a vasopressor, immunomodulating, immunosuppressive, antiviral therapy, assistive devices, or heart transplantation.
In the absence of symptoms of heart muscle inflammation, medication is rarely prescribed. To normalize the condition, it will be enough for the patient to observe bed rest for some time, to limit physical activity. Also, patients are prescribed a low-salt diet.
With severe pain, inflammation of the heart muscle is treated with painkillers.
Myocarditis without treatment can lead to chronic dilated cardiomyopathy (distention of the heart cavities with a disturbance in the rhythm of the heartbeat). In this case, the risk of death is increased.
Drug treatment
How to relieve inflammation of the heart muscle? To do this, eliminate the causes of the disease. Depending on the nature of the occurrence of inflammation, the attending physician prescribes appropriate medications.
Medication for myocarditis may include:
- Antimicrobials (antibiotics) to fight bacterial infections.
- Steroids to reduce swelling.
- Intravenous administration of immunoglobulin to increase the number of antibodies necessary to fight the inflammatory process.
- Diuretics to remove excess water from the body. Thus, the load on the heart is reduced.
- Drugs for normalizing heart rate. These include ACE inhibitors (angiotensin converting enzyme), beta-blockers and angiotensin receptor blockers, which can be prescribed for the treatment of pulmonary hypertension.
- Blood thinning medications to reduce the risk of blood clots.
- Drugs for the treatment of heart failure while weakening the heart muscles.
In rare cases, with autoimmune diseases, drugs can be used to suppress the body's immune response.
Surgery
Patients with more severe cases of myocarditis may need surgical or other interventions.
The following types of treatment are distinguished:
- Auxiliary ventricular devices. They are a pump used in cases where the heart cannot pump enough blood. Some of them are located inside the body, while others have parts inside and out.
- Pacemaker It is established in patients with bradycardia (slow heartbeat) and heart failure.
- Intra-aortic balloon counterpulsation (IABC) is an apparatus that helps the heart pump blood throughout the body. It is used when the body is not able to independently pump enough blood. A special balloon is inserted through the femoral artery into the groin and inserted into the aorta. The balloon is deflated and inflated, saturating the blood with oxygen, and, thereby, reduces the load on the heart.
- ECMO (extracorporeal membrane oxygenation). In this case, the blood is run through a special apparatus to increase the amount of oxygen, and then transfused into the body.
- Heart transplantation. An organ transplant may be necessary in very severe cases when the disease can not be cured with drugs. An artificial or donor heart is transplanted to the patient. The disadvantage of this operation is the need for lifelong administration of immunosuppressive drugs. This therapy is mandatory to eliminate the risk of organ rejection.
Forecast
The duration and outcome of treatment may vary depending on the cause of the disease and the general state of human health. In most cases, with myocarditis caused by viruses or bacteria, the patient's condition improves with treatment without any complications. About a third of people who have had inflammation of the heart muscle recover completely over time. Others may have prolonged heart failure. In severe cases, inflammation of the heart muscle does not pass without a trace, and the patient requires lifelong administration of maintenance medications. In situations where inflammation and heart damage are critical, the only treatment option is a heart transplant.
Effects
In the absence of adequate treatment, inflammation of the heart muscle can lead to other complications, for example:
- Cardiomyopathy is a disease in which the muscle tone of the heart decreases and its ability to pump blood throughout the body decreases.
- Heart failure is a violation of the blood circulation in the body.
- Pericarditis is a disease that causes inflammation of the pericardium. The pericardium is a fluid sac that encloses the heart.
Prevention
Myocarditis caused by infections can theoretically be avoided by maintaining daily hygiene, especially hand washing. Myocarditis of infectious and viral etiology can be prevented by immunization. Infection with HIV can be avoided by using safe methods of sex, eliminating intravenous drug use.
Among other things, measures to prevent the occurrence of inflammation of the heart muscle include:
- Compliance with a healthy and balanced diet.
- A selection of low fat foods. It can be skinless poultry, not fried fish, beans, milk, and low-fat dairy products.
- Eating low sugar foods.
- Moderate physical activity.
- Do not self-medicate. Taking medications should be carried out only as prescribed by the attending physician.
- Compliance with a healthy lifestyle. Quitting smoking, taking alcohol and drugs.
- Regular medical examination.
- Support for optimal body weight.
- Finding ways to control and manage stress.
- Reducing the amount of salt consumed.
- Rest and long sleep.
When to contact?
If symptoms of myocarditis are found, especially after a recent infectious disease, you should consult your doctor.
In cases of persistent and increasing chest pain, swelling, or breathing problems, especially with previous inflammation of the heart muscle, contacting a medical institution should be immediate.
Finally
Inflammation of the heart muscle. What it is? This is an inflammation of the muscle walls of the heart. Early diagnosis of the disease is key to preventing complications.
The causes and treatment of inflammation of the heart muscle are diverse. Distinguish infectious, toxic, autoimmune etiology. Infectious, especially viral, is most often found in children. The choice of treatment for inflammation of the heart muscle depends on the cause of the disease and its severity. Regardless of the type of therapy, the goal is to support the work of the heart. In the absence of symptoms of inflammation of the heart muscle, treatment in adults and children is not prescribed.
Myocarditis affects children differently depending on the cause, general health and age of the child. Most of them fully recover from inflammation of the heart muscle with appropriate treatment. At the same time, others may develop chronic heart failure. Newborns have a higher risk of serious complications.
If severe life-threatening symptoms of inflammation of the heart muscle are manifested, treatment should be started immediately. In these cases, the heart can be damaged so badly that only an organ transplant is needed to save the patient.