Rheumatic myocarditis is characterized by damage to the muscular membrane of the heart, and the disease develops against the background of the course of rheumatism. If the first signs of the disease occur, you should definitely visit a doctor for diagnosis and treatment.
Rheumatic myocarditis always occurs due to rheumatic fever. This form of the disease is characterized by the fact that the main complaint of the patient is pain in the heart. Painful manifestations are constant, dull in nature. Basically, they are long-lasting, occur periodically and intensify during physical exertion.
For rheumatic myocarditis, it is characteristic that it proceeds with a violation of the rhythm and conduction of the heart. Cardiovascular failure develops only in the most advanced cases.
Main forms
There are several forms and types of rheumatic myocarditis, among which it is necessary to highlight the following:
- spicy;
- fleeting;
- persistent chronic;
- chronic active.
Acute rheumatic myocarditis develops very quickly, which often leads to arrhythmia and heart failure. In some cases, the disease is fatal. The transient form of myocarditis provokes a violation of the functionality of the left ventricle of the heart, which is accompanied by the destruction of its cells and cardiogenic shock.
A chronic persistent type of disease is characterized by the fact that the work of the heart muscle is fully preserved until the transition of the disease to the stage of active border myocarditis. At the initial stages of development, there is no pronounced symptomatology, as a result of which complications may occur and heart failure may appear. It is impossible to eliminate it even after stopping the inflammation.
The chronic active stage of rheumatic myocarditis combines signs of an acute and transient form. There is a high risk of developing cardiomyopathy. Foci of inflammation may persist after complete recovery. Sometimes the disease is complicated by fibrosis, which is accompanied by pathological proliferation of tissues, as well as scarring.
The chronic form appears in the absence of timely diagnosis and treatment of acute manifestations of pathology. In a chronic course, the disease is recurrent in nature, exacerbated by the development of viral diseases and the presence of many other provoking factors.
Symptom classification
There are various types of rheumatic myocarditis, differing in clinical manifestations, namely:
- asymptomatic;
- pain
- arrhythmic;
- pseudo valve;
- decompensation;
- thromboembolic;
- mixed.
The low-symptom form is characterized by the fact that the patient is concerned about slight weakness, fatigue, but there are no signs of heart disease. With pain, the occurrence of pain in the sternum is characteristic. They can be of a different nature and resemble ischemia.
With the decompensation type, signs of circulatory disorders are noted. Puffiness appears, and skin can also become cyanotic. The arrhythmic form of myocarditis is caused by a violation of the heart rhythm. It can be arrhythmia or bradycardia.
Thromboembolic type of disease is characterized by the fact that with this type of myocarditis there is a likelihood of a blood clot in the pulmonary artery and blood vessels. With pseudo-valve myocarditis, deformation of the valves of the heart muscle occurs, which is manifested in the occurrence of noise in the heart. The mixed type may have symptoms of all types of disease.
Main reasons
Rheumatic myocarditis is a rather complicated pathology that occurs a few days after previously transferred infectious diseases. Joints and soft tissues are initially affected by streptococci. Among the main factors affecting the development of the disease, it is necessary to highlight the following:
- the specificity of the antigenic properties of streptococcus;
- the response of the body at the immune level to the presence of bacteria;
- genetic predisposition;
- frequent damage by pathogens.
All these provoking factors lead to the development of systemic diseases, in particular, such as rheumatism, against which rheumatic myocarditis develops. The infection usually affects all tissues of the heart.
This disease can appear as a complication of an infection, for example, flu, tonsillitis, chlamydia, scarlet fever, herpes. The most severe forms occur against the background of sepsis.
Main symptoms
Symptoms of rheumatic myocarditis can periodically occur and disappear. Often, the disease does not have any pronounced signs until the onset of complications. Among the main symptoms of rheumatic myocarditis, the following can be distinguished:
- pain;
- dyspnea;
- a slight increase in temperature.
The leading clinical symptom of rheumatic myocarditis is pain in the heart. It is worth noting that it is very rarely intense. Basically, it is aching, pulling, weakly expressed and does not cause very strong anxiety in patients. In addition, a person may also be bothered by aching joints.
With myocarditis, shortness of breath is not very strong and occurs only during physical exertion, so a person does not always pay attention to the presence of a problem. If dyspnea occurs at rest, then you must definitely visit a doctor for a full examination. With the course of the disease, the temperature can rise to 38 degrees and hold for a long time. With a sluggish infection, the temperature rises slightly.
In the case of myocarditis, all these signs or only part of them may appear. The clinical picture largely depends on how much the infection has spread and where it is localized. In the initial stages, the disease is almost asymptomatic.
What does the patient look like
The appearance of a patient with myocarditis largely depends on how the disease proceeds, as well as on its severity. With a mild course and at the initial stage of the patient, it is practically impossible to distinguish from a healthy person, since only general weakness worries him. As the disease progresses, with its moderate course and in an advanced stage, a person has a pale skin tone, and his fingers and lips turn blue.
With the decompensated form, swelling of the veins on the neck is clearly visible, which is especially noticeable during physical exertion. When walking, marked shortness of breath is noted, which causes a person to stop periodically to rest. This form is characterized by the appearance of edema of the legs. If any of these signs occur, you should visit a doctor.
The first signs of pathology can occur 3-8 weeks after the occurrence of any infectious disease. It can be a cold, flu, tonsillitis.
Diagnostic measures
With rheumatic myocarditis, the diagnosis is rather difficult, since for a long time specific signs may be absent. Diagnostics consists of the following steps:
- history taking;
- laboratory research;
- instrumental examination.
Initially, the doctor collects an anamnesis, talks with the patient, finds out what complaints there are, the reasons for their appearance, as well as the nature of the change in symptoms over time. Particular attention is paid to previously transferred diseases, especially in the case of bacterial and viral infections.
Examination of the patient is aimed at identifying signs of heart failure, such as swelling of the legs, shortness of breath, blueness of the skin, swelling of veins in the neck. Then the doctor listens to the lungs and heart. With myocarditis, the presence of muted tones is noted. On the part of the lungs, respiratory depression is often observed as a result of the occurrence of blood stasis.
Percussion implies that the doctor taps to determine the boundaries of the heart. Laboratory and instrumental examination is considered a very important stage of diagnosis, as this allows you to accurately determine myocarditis in its presence. For this, the following types of examinations are shown:
- electrocardiogram;
- pressure measurement;
- ultrasound diagnostics;
- radiography;
- tomography;
- scintigraphy;
- blood and urine tests.
To conduct the diagnosis of this disease, various specialists are involved, in particular, rheumatologists, cardiologists, radiologists. With rheumatic myocarditis, a micropreparation of the heart is of great importance, since an increase in the size of the heart muscle can be determined. In this case, the myocardium becomes weaker, and the valve flaps are thickened. Only then can a correct diagnosis be made.
Treatment features
In the acute period of the course of the disease, the patient must be hospitalized in a hospital, regardless of whether the pathology first occurred or this exacerbation. The patient is required to limit physical activity, so it is important to observe bed rest. All these measures are aimed at reducing the load on the heart and compensating for cardiac activity.
When conducting therapy, it is very important to follow a special diet, which implies:
- limitation of fluid intake;
- a decrease in the amount of salt;
- the exception of fried foods, smoked meats, pastries, meat.
Myocarditis treatment is aimed at eliminating the causative agent of the disease, the causes of inflammation and the main symptoms. The appointment of antiviral agents, antibiotics is carried out only if there is a suspicion of the presence of an appropriate pathogen in the body. In this case, it is necessary to exclude all signs of a chronic infection in the body.
When prescribing antibacterial agents, it is desirable to initially determine the sensitivity of the pathogen to these drugs. You can eliminate inflammation with the help of glucocorticosteroids, anti-inflammatory and antihistamines. To eliminate the external signs of the disease, anticoagulants, antiarrhythmic drugs and drugs to increase blood pressure are prescribed.
During the treatment, it is necessary to maintain the myocardium, therefore, doctors prescribe drugs that stimulate metabolism and normalize the nutrition of the heart muscle. Necessarily need vitamin complexes. The duration of treatment is approximately 4 months, and then a rehabilitation course is required.
Folk techniques
Folk remedies are only ancillary therapy in the treatment of this disease. They can be used with the permission of a doctor, so as not to provoke a deterioration in well-being. Among folk remedies, doctors distinguish such:
- garlic;
- herbal preparations;
- Birch juice.
Garlic is considered one of the most beneficial foods for heart muscle. The substances it contains help prevent heart attack and blood clots. It can be taken fresh or prepared infusion. With myocarditis, such plants will be useful:
- hawthorn;
- fennel;
- horsetail;
- motherwort.
From these herbs, you can prepare an infusion and take it during the day in small portions. Natural birch sap helps strengthen the myocardium and eliminate puffiness. To prepare the medicine, you need to mix birch, lemon juice, as well as honey.
Folk remedies have a cumulative effect, in order to achieve a positive result, you need to take them in courses and strictly follow the dosage.
Features of the disease in childhood
Rheumatic myocarditis in children differs in the diffuse appearance of the affected myocardium, which leads to the occurrence of stagnant processes in the circulatory system. Children get sick much more often than adults, since their immunity is not yet fully formed. Frequent diseases provoked by streptococci lead to the development of pathology. This can be due to the occurrence of inflammation in the body.
Foci of a chronic infection can provoke the onset of the disease, which leads to sensitization of the body. Also, overfatigue, hypothermia and unhealthy nutrition play an important role in disrupting the immune system. Outbreaks of acute rheumatic fever may be due to improper use of antibacterial drugs.
Among the symptoms of rheumatic myocarditis in children, difficulty breathing, fever, chills, and even fainting need to be distinguished. In addition, pain in the sternum can be observed. The leading clinical symptom of rheumatic myocarditis in children is considered pain in the joints, as well as the presence of aching pain in the heart.
During therapy, bed rest is required. As a medical treatment, antibacterial agents and anti-inflammatory drugs are used. With incorrect or untimely therapy, various kinds of complications can develop.
Possible complications
Myocarditis can lead to many different consequences. Its course depends on the characteristics of the body, immunity, as well as the stage of development of the disease. Complications can affect the heart and other organs. The most common consequences of myocarditis include:
- thromboembolism;
- ascites;
- heart failure;
- cardiosclerosis.
Ascites is characterized by the accumulation of fluid in the abdominal cavity. In this case, the stomach increases in size, there is a feeling of heaviness and bursting. Thromboembolism is a serious condition in which a thrombus becomes clogged with a vessel or artery. Blood circulation is disturbed, various complications develop. If the blood clot breaks, then this can lead to secondary blockage of the artery and death of the patient.
With cardiosclerosis, scar tissue forms, which over time grows and reduces the contractility of the heart. The most dangerous complication is heart failure and sudden cardiac arrest.
Prevention and prognosis
Proper nutrition and a healthy lifestyle helps protect the heart from various kinds of diseases. With timely treatment, the prognosis is quite good. Many suffer this disease without complications. With the wrong treatment, the pathology can become chronic. In this case, relapses will alternate with remissions.
With a severe course of the disease, it can lead to heart failure, which increases the risk of death. To prevent the development of myocarditis, you need to adhere to the basic rules of prevention, which includes:
- hardening;
- proper nutrition;
- timely treatment of infectious diseases;
- rejection of bad habits.
All these preventive measures help not only prevent the development of myocarditis, but also many other heart diseases.