A concept such as carditis was recently introduced into pediatric clinical practice. It refers to the simultaneous damage to the heart membranes - peri-, endo- and myocardium.
Until recently, the term "myocarditis" has been used to refer to myocardial inflammation caused by bacterial and viral agents.
But as has been shown in numerous recent studies, in children with bacterial and viral myocarditis, peri- and endocardium are included in the disease process in almost all cases. For this reason, the use of the concept of "myocarditis" does not fully reflect the essence of the pathological process. Based on this, it was proposed to use in pediatrics a term such as “cardit”.
To indicate the differences of carditis, which are of non-streptococcal origin, until recently the concept of “infectious-allergic” was used. But from the standpoint of the present state of affairs in the pathogenesis of the disease, such a term cannot be considered true. Now non-streptococcal carditis in pediatrics is designated as non-rheumatic.
Description of this pathology
In children, non-rheumatic carditis is an inflammatory process in one or more cardiac membranes that is not caused by rheumatic or other systemic pathology. The course of this disease is accompanied by shortness of breath, tachycardia, cyanosis, heart failure, arrhythmia, and the child's physical lag. During diagnosis, children take into account laboratory, clinical, radiological and electrocardiographic information. In the treatment of pathology in pediatrics, cardiac glycosides, hormones, NSAIDs, metabolic, antimicrobial, diuretic and antiviral drugs are used.
The development of the disease in pediatrics
In children, non-rheumatic carditis (according to ICD 10 - I51.8) is a group of inflammatory processes in the heart, mainly of an infectious-allergic origin. The expediency of classifying them in pediatrics is due to both isolated and in many cases combined lesions of two and three heart membranes in small patients. In pediatric cardiology, among non-rheumatic carditis, endo-, peri- and myocarditis are found, as well as pancarditis and myopericarditis. The true prevalence of this pathology among children is not exactly known; autopsy data suggest that the disease is diagnosed in 3–9% of patients. Non-rheumatic carditis is detected in children of any age category, but among them the vast majority of young patients, mainly males.
The causes of this disease
In a child, the ailment can be caused by allergic immunological or infectious factors. Among the infectious agents, viruses (Coxsackie B and A, ECHO, influenza viruses of type B or A, adenoviruses), bacteria (staphylococcus and streptococci), fungi, rickettsia, and associated flora are especially strong.
Congenital non-rheumatic carditis in children occurs due to intrauterine infections that affect the fetus. Bacterial carditis is often a complication of sepsis, nasopharyngeal infection, diphtheria, hematogenous osteomyelitis, and salmonellosis.
Allergic immunological carditis
Allergoimmunological carditis can develop as a result of vaccination, taking medications and administering serum to the patient. Often there is an infectious and allergic origin of heart damage. In approximately 10% of small patients, the etiology of non-rheumatic carditis remains unknown.
Predisposing factors for the development of the disease
Predisposing factors due to which the viral and bacterial microflora is enhanced, as well as susceptibility to allergens and toxins, changes in immunological reactivity occur, infections transmitted by the child, intoxications, physical and psychoemotional overloads, hypothermia, previous surgical interventions on the vessels and heart can become thymomegaly. In some children with this pathology, hereditary defects of immune tolerance are detected.
Classification of non-rheumatic carditis in children
Thus, depending on the origin, idiopathic, viral, allergic, bacterial, fungal, parasitic carditis are distinguished in small patients. In infectious-allergic carditis, there is such a variety as Abramov-Fiedler myocarditis.
Given the time factor, carditis is divided into congenital (may be early and late), as well as acquired. The duration of the pathology can be chronic (over 18 months), subacute (no more than 18 months) and acute (no more than three months). The severity of the disease can be mild, severe, and moderate. This is the most common classification of non-rheumatic carditis in children.
Congenital carditis: symptoms
Congenital early carditis most often declares itself immediately after birth or in the first six months of a child's life. The baby is born with moderate-type hypotrophy, from the first days he has rapid fatigue and lethargy when feeding, perioral cyanosis and pallor of the skin, sweating, anxiety for no reason. Dyspnea and tachycardia at rest increase even more with crying, sucking, bathing, bowel movements, and swaddling. Children with non-rheumatic congenital carditis show marked lags in physical development and weight gain. Already in the first months of life, babies have a cardiac hump, cardiomegaly, edema, hepatomegaly, heart failure, refractory to therapy.
The clinic of congenital late non-rheumatic carditis in pediatrics is developing in the 2-3rd year of life. Often affects two or three heart membranes. Symptoms of heart failure and cardiomegaly are less expressed in comparison with early carditis, but in the clinical picture there are especially severe violations of conduction and rhythm (complete cardiac atrioventricular block, atrial flutter, etc.). If the child has a convulsive syndrome, this indicates an infectious lesion of the central nervous system.
Cardites acquired
Non-rheumatic carditis in children especially often develops at an early age against the background of the infectious process. Among nonspecific signs, irritability, weakness, attacks of cyanosis, an obsessive cough, encephalitic and dyspeptic reactions are noted. Gradually or sharply, left ventricular failure appears, characterized by congestive wheezing and shortness of breath in the lungs. The clinical picture of childhood non-rheumatic carditis is usually characterized by various defects in conduction and rhythm (sinus bradycardia or tachycardia, atrioventricular and intraventricular blockade, extrasystole).
Subacute carditis - what is it characterized by?
Subacute carditis is characterized by severe fatigue, arrhythmia, pallor, and insufficient heart activity. Non-rheumatic chronic carditis is mainly observed in schoolchildren, occurs with minor symptoms, mainly with extracardial manifestations (fatigue, weakness, physical developmental delays, sweating, abdominal pain, nausea, dry, obsessive cough). It is very difficult to recognize chronic carditis. Often, children are unsuccessfully treated for a long time by a pediatrician with such diagnoses as hepatitis, pneumonia and chronic bronchitis.
Diagnosis of this disease
Diagnosis of non-rheumatic carditis in pediatrics requires the mandatory presence of a pediatric cardiologist. During the collection of the medical history, it is important to establish a relationship between the manifestation of the disease and previous infections and other provoking factors.
The diagnosis of non-rheumatic carditis can be established using a number of clinical and instrumental information. Electrocardiography does not show pathognomonic symptoms: in children, persistent heart rhythm defects are usually determined for a long time; blockade of the legs of the bundle of His, AV blockade, symptoms of hypertrophy of the left heart.
When chest x-rays are determined, cardiomegaly, increased lung pattern due to venous stasis, a change in the shape of the heart shadow, symptoms of pulmonary interstitial stasis.
With non-rheumatic carditis on the echocardiogram, dilatation of the cardiac cavities, a decrease in the contractile activity of the left ventricular myocardium, as well as ejection fraction can be detected.
During an immunological blood test, an increase in immunoglobulins and an increase in viral antibody titers are detected. The most accurate diagnostic data can be obtained through endomyocardial biopsy of the heart muscle.
Non-rheumatic congenital carditis in children should be distinguished from congenital heart defects (primarily Bland-White-Garland syndrome, Ebstein anomaly, open atriventricular canal), perinatal hypoxia.
Acquired carditis needs to be distinguished from cardiomyopathy, cardiac tumors, rheumatism, mitral valve prolapse, arrhythmias of a different genesis, constrictive pericarditis.
Treatment of non-rheumatic carditis
Treatment of pathology includes inpatient and outpatient rehabilitation stages. During hospitalization, the patient's motor activity is limited - bed rest is required to be observed for 2-4 weeks. The diet is based on a diet with an increased content of vitamins and potassium salts. The child is assigned to exercise therapy, accompanied by an instructor.
Treatment of non-rheumatic carditis of viral etiology includes ACE inhibitors, NSAIDs, antiarrhythmic drugs, glucocorticosteroids, anticoagulants, glycosides, antiplatelet agents, cardiac diuretics, metabolic drugs, etc. If the etiological factor of the disease is known, the patient is prescribed the necessary etiotropic therapy (antibiotics, interferons, immunoglobulins).
What happens on an outpatient basis?
At the outpatient stage of the treatment of non-rheumatic carditis in children, rehabilitation procedures are required in the sanatorium conditions of the cardio-rheumatological profile. In children after a subacute and acute illness, dispensary observation is carried out for two to three years, chronic and congenital types require observation throughout life. Preventive vaccinations for small patients who have had the disease are done after they have been removed from the dispensary, and in case of chronic carditis, vaccination is contraindicated.
Now you know the danger of non-rheumatic carditis in pediatrics. To protect your baby from an unwanted illness, you should monitor his health and observe preventive measures.
Prediction and prevention of this pathology in babies
If the events develop favorably, then the symptoms of heart failure gradually regress, the size of the heart decreases, the heart rate returns to normal. Light types of childhood non-rheumatic carditis most often end in complete recovery. Severe forms can be fatal in 80% of cases. Factors that aggravate the prognosis are as follows: progressive heart failure, pulmonary hypertension, cardiosclerosis, persistent conduction and rhythm defects.
Prevention of non-rheumatic congenital carditis in pediatrics is to prevent the possibility of infection of the fetus inside the womb. Hardening of the baby, prevention of complications after vaccination, and therapy of focal infections will also help to eliminate pathology.
We reviewed clinical guidelines for non-rheumatic carditis.