Myocarditis in a child: diagnosis, symptoms and treatment. Children's Cardiology Center

Myocarditis in a child is relatively often diagnosed in modern medical practice. It is worth immediately saying that this ailment is dangerous and, if untreated, can lead to serious complications. That is why many parents are interested in information about this disease. Why does such an ailment develop even in infants and what symptoms should I pay attention to? What does the therapy look like and what are the prognoses for small patients?

Features and characteristics of the disease

The term "myocarditis" means a disease that is accompanied by an inflammatory process in the heart muscle. This disease is diagnosed in patients of different ages. Myocarditis in a child or adolescent can hardly be regarded as a rare case.

The causes of inflammatory myocardial damage can be very different, ranging from penetration into the tissue of the infection and ending with severe allergic reactions and intoxications. Quite often, inflammation covers not only the heart muscle, but also neighboring structures, including the pericardium, blood vessels, and other organs.

The main causes of myocarditis

It is believed that inflammation of the heart muscle can be associated with almost any known form of infection:

• In most cases, the “culprits” of myocarditis are viruses - adenoviruses, Koksaki enteroviruses, as well as parvoviruses, cytomegalovirus, hepatitis viruses and influenza.
• Myocardial inflammation sometimes has a bacterial origin. The disease develops against the background of tuberculosis, brucellosis, bacterial meningitis. The inflammatory process appears when streptococcal infection is activated.
• The defeat of the body by rickettsia often leads to inflammation of the heart muscle. Risk factors include Q-fever, typhus, Rocky Mountain Fever.
• Pathogenic fungi, in particular, Candida fungi, can act as a pathogen.
• There are protozoal myocarditis, developing against the background of toxoplasmosis, malaria, leishmaniasis.
• Helminths (echinococci, trichinella) also provoke an inflammatory process.
• There is also toxic myocarditis caused by the ingestion of arsenic, mercury, and carbon monoxide.
• Sometimes the disease develops while taking medications, after vaccination or the introduction of sera.

• Risk factors include snake and insect bites.
• Physical exposure, for example, severe hypothermia, overheating, exposure to ionizing radiation on the body also provokes an inflammatory process.
• Other risk factors include systemic lupus erythematosus, rheumatoid arthritis, and some other autoimmune diseases.

As you can see, there are a huge number of reasons why myocarditis develops. Diagnosis should include a search for the primary disease, since the success of therapy depends on this.

Forms and varieties of the disease

There are several classification schemes for this disease. The options for the development of the disease, depending on the cause, have already been considered above. But during the diagnosis, experts pay attention to other factors:

• If we are talking about the course of the disease, then myocarditis can be acute, chronic or subacute.
• Depending on the severity, the disease can be mild, moderate or severe.
• The doctor also draws attention to the clinical manifestations - in children you can notice a typical form of inflammation, as well as an erased and asymptomatic one.
• The degree of spread of the inflammatory process also matters - in this case, focal (there is an isolated, single site of inflammation) and diffuse myocarditis (pathology spreads to the entire muscle) are distinguished.

How does myocarditis develop in children? Main stages

Myocarditis in a child develops in several stages - in modern medicine there are three:

1. Stage of viremia - viral particles (or other pathogens) enter the myocardium. First, they are fixed on the surface of muscle cells, and then penetrate into myocytes. At this stage, the activation of the immune system is observed, which is accompanied by increased synthesis and release of interferon.
2. The autoimmune stage, in which the immune cell response is significantly enhanced and the level of anticardial antibodies that accumulate in the myocardium increases, negatively affecting its work. At the same stage, inflammatory mediators are activated . Damage to microvessels is observed.
3. If the course of the disease is favorable, then there is a decrease in edema and the formation of fibrous areas on the heart muscle. If the therapy did not give positive results (or was completely absent), the ailment becomes chronic. In chronic inflammation, complications gradually develop, including heart failure, cardiomegaly, cardiosclerosis.

The process of diagnosis and examination of the child helps the doctor find out the form of the disease, its causes, as well as the stage of development - only after receiving these data can a really effective treatment regimen be drawn up.

Symptoms of the disease in the newborn

The symptoms of the disease depend on many factors - here it is worth taking into account the child's age, origin and form of the disease. Myocarditis is most severe in newborns. The baby slowly gains weight, becomes drowsy and inactive, since even the feeding process makes him very tired. The skin of the child is pale, often acquires a gray tint.

Another symptom is shortness of breath. First, it appears during periods of activity - the baby breathes quickly and hard during dressing, bathing, bowel movements, and feeding. As the disease progresses, breathing difficulties can already be observed in a calm state. Due to developing heart failure, edema appears - sometimes they are very pronounced, due to which the baby's weight increases sharply. Examination of the child reveals an increase in the liver and spleen.

Features of the clinical picture in a child older than two years

In older children, the clinical picture looks different. Within 2-3 weeks after the primary infection, myocarditis does not appear at all. Then the symptoms become more pronounced. Signs of illness include:

• pallor of the skin ;
• fatigue, weakness, a slight increase in temperature;
• loss of appetite and, consequently, weight loss;
• soreness in the muscles and joints, and sometimes in the abdomen;
• as the disease progresses, children begin to complain of pain in the heart;
• shortness of breath and palpitations appear.

Myocarditis: diagnosis of the disease

With such a disease, the correct diagnosis is of great importance. With a child, it is best to contact a children's cardiology center. The following procedures are required for diagnosis:

• First, a survey of the child and parents is carried out in order to make an anamnesis, to determine the presence of certain symptoms.
• Already during the examination, the doctor may suspect myocarditis - a specialist observes pallor, even cyanosis of the skin, rapid heartbeat, the presence of edema and shortness of breath.
• A biochemical and serological blood test is performed, which allows you to determine the presence of infection and the inflammatory process.
• Chest x-ray allows a specialist to see the expansion of the borders of the heart and the presence of stagnation of blood in the vessels of the lungs, which confirms the presence of an inflammatory process in the myocardium.

• Electrocardiography and echocardiography are necessarily performed - such procedures make it possible to examine the functioning of the heart and assess the degree of disturbance.
• Myocardial biopsy is indicated only in the most severe cases, as it helps to determine the degree of spread of the inflammatory process.

Treatment of the disease: what do doctors offer?

Of course, therapy depends on the cause and degree of development of the disease. For example, in the presence of a bacterial infection, antibiotics are needed, and for viral lesions, antiviral medications are indicated. Also, children are prescribed immunomodulators, which allow normalizing the work of protective mechanisms.

To eliminate the inflammatory process, patients take anti-inflammatory non-steroidal drugs (Voltaren, Brufen, Indomethacin). In especially severe cases, steroid hormonal drugs are used that are more effective in fighting inflammation. To eliminate edema, diuretics are used to get rid of excess fluid. It is also important to include vitamin preparations in the therapy regimen. If we are talking about a chronic process, then sanatorium treatment is indicated. If persistent arrhythmia occurs that is not amenable to drug treatment, implantation of a pacemaker may be necessary.

Treatment is carried out in a hospital, it is advisable to choose a good children's cardiology center with good specialists. At the end of the course of therapy, the child should still undergo regular examinations - first every few months, and then twice a year (with a favorable course of the disease). Echo and electrocardiography, chest x-ray, blood tests should be done periodically - this is the only way to notice a relapse or the presence of complications in time.

Myocarditis baby diet

Many parents today are interested in questions about why it develops and what myocarditis is in a child. Symptoms and treatment of the disease, its causes are, of course, important points. But it is worth considering that during therapy, the child needs a special diet (if it is not about babies).

Experts recommend abandoning simple carbohydrates - do not give your child buns, chocolate, white bread, pasta. You can replace them with baking without yeast. Also, do not abuse salty and spicy foods, fatty meats and fish, rich soups and broths - it is better to eat low-fat chicken fillet and liver (by the way, it is advisable to cook dishes for a couple). Fish is allowed, but only when it comes to low-fat varieties. The number of eggs also needs to be limited.

The diet should include fermented milk products, fresh fruits and vegetables (except for plums, quinces, pears and apples, grapes). Chocolate and other sweets can be replaced with honey, jam, marshmallows and marmalade.

Myocarditis Predictions

Myocarditis in a child is especially dangerous in the first months of life - it is in this age group of patients that the death is most often observed. Predictions depend on the form and severity of the disease. For example, a mild form of the disease sometimes does not require treatment at all. Bacterial inflammation is easier to treat, but with a viral infection, the outcome of the disease may not be too good.

Adverse events are rarely recorded among school-age children and adolescents - as a rule, children recover quite quickly and return to normal life. True, sometimes during myocarditis sclerotic areas form in the heart, which can cause the development of heart failure in adulthood.

Prophylactic agents

Unfortunately, there is no universal remedy for myocarditis. Nevertheless, experts recommend following certain rules. A pregnant woman should be careful about her health, prevent the development of infectious diseases, avoid contact with toxins, and regularly take tests.

The condition of the newborn should be carefully monitored - infectious and inflammatory diseases should be diagnosed and treated on time. During outbreaks of colds, if possible, do not allow the child to come into contact with infected people. A good diet, a clear daily routine, moderate physical activity and hardening will positively affect the state of the immune system.