What is myocarditis? This is an inflammation of the muscle membrane of the heart, which is usually infectious-allergic, infectious and rheumatic in nature. It is quite common, so now itโs worthwhile to talk in detail about the symptoms of myocarditis, its types, as well as the specifics of diagnosis and treatment.
Etiology
First of all, one should list the reasons why this disease overcomes a person. Myocarditis includes a rather large group of diseases of the heart muscle of inflammatory genesis, which are manifested in the defeat and impaired myocardial function. The most common causes are:
- Toxins that damage cardiomyocytes (muscle cells of the heart). They are released into the blood by any pathogen in the presence of a systemic infection, and are transmitted directly to the heart. As a rule, diphtheria myocarditis develops for this reason.
- Coronaryitis This is a syndrome that occurs with rheumatism, dermatomyositis and lupus erythematosus. It, as well as endothelial vascular dysfunction, leads to damage to the heart muscle.
- Nonspecific myocardial cell damage. Autoimmune diseases lead to this, and myocarditis begins to develop in the future.
- Specific muscle cell damage. Here factors of cellular and humoral immunity play a role, which are activated when a pathogen appears in the body or a primary infection begins to develop.
- Viral diseases. Hepatitis B and C, adenoviruses, herpes, influenza, as well as Coxsackie viruses spreading in the gastrointestinal tract.
- Bacterial diseases. They are usually provoked by various parasites - rickettsia, salmonella, coryneobacterium diphtheria, streptococcus, chlamydia, staphylococcus.
- Fungal diseases. Candida and aspergillus provoke their development.
- Parasitic diseases. Their causative agents are echinococci and trichinella.
It should be noted that severe acute myocarditis often occurs with sepsis, scarlet fever and diphtheria.
Also, it often becomes a consequence of diseases that affect the connective tissue - arthritis, vasculitis, rheumatism, systemic lupus erythematosus. In fact, even the systemic use of heavy drugs, alcohol, and ionizing radiation can cause damage to the heart muscle.
Rheumatic myocarditis
Depending on the cause of occurrence, several types of myocarditis are distinguished. The first one I would like to talk about is rheumatic. In order for it to develop, the following factors must converge:
- The presence in the body of a pathogenic agent - ฮฒ-hemolytic streptococcus group A. It has special antigenic properties that are similar to those in the structures of the brain, heart and serous membranes.
- The body's immune response to streptococcal invasion.
- The predisposition of a person to the disease. Usually the reason lies in a family history.
- Sensitization of the body. Under the โonslaughtโ of streptococci, it can break only with a second attack. That is why young children are resistant to them.
Symptoms of this type of myocarditis include:
- Joint pain.
- Acute attacks of rheumatism.
- Elevated body temperature.
- The formation of subcutaneous nodules.
- Chorea. It appears in irregular, jerky, erratic movements.
- Polyarthritis (joint disease).
- Ring-shaped erythema.
In fact, the symptoms can hardly be called specific. Of the most obvious manifestations, one can note asthenic syndrome, a change in irritability, tearfulness, and sleep disturbance. Also, a person is worried about discomfort in the heart, unexpressed pain, mild shortness of breath and fatigue.
Infectious myocarditis
If there is a malfunction in the human immunity, then it will affect all levels - from cellular to phagocytosis. Because the bacteria that provoke the development of the disease, change the composition of muscle fibers, as a result of which exudative reactions develop. This gives rise to the proliferation of connective tissue, and as a result, everything leads to cardiosclerosis.
If acute myocarditis of an infectious nature is not treated, chronic circulatory failure, poor conductivity, and heart rhythm disturbances may develop. As a result, everything often leads to death. And indeed, 90% of patients whose doctor diagnosed this disease receive a disability group.
Specific symptoms, in addition to chest discomfort and heart pain, include:
- Fatigue too fast in the absence of special loads. Intense sweating.
- Constantly palpitations and shortness of breath.
- Febrile conditions.
- Pain in the sternum.
- Joint pain.
- Blanching of the skin.
- Insomnia.
- Constant mood changes.
- Nervous overexcitation.
- Tearing.
In the further stages of myocarditis, severe pain begins to appear, independent of stress and physical activity, obvious malfunctions in the heart rhythm and tachycardia. At the last stage of development, as a rule, decompensation of the ventricle of the left chamber occurs.
Allergic myocarditis
Talking about a disease of this type, it is worth listing several factors contributing to its appearance. The reason may be either one of the above, or:
- The intake of drugs in bulk. The abuse of sulfa drugs and antibiotics may well provoke the development of myocarditis symptoms.
- Vaccinations. Especially at an older age.
- Poisoning by toxic substances.
- Tissue or organ transplant surgery. The greatest risk arises when replacing heart valves.
There are no specific symptoms. But those patients who have suffered from this type of disease have impaired immune reactivity. They appear in neurodermatitis, urticaria, bronchitis, autoimmune pathology and bronchial asthma.
There are also some changes in the body that cannot be noticed with an armed gaze. They can be distinguished in the following list:
- Decreased absorption of oxygen and glucose from the blood.
- Slowing down energy production by myocardial cells.
- Metabolic disorders and inactive excretion of metabolic products.
- Changing the balance of electrolytes.
After this, cardiosclerosis begins to develop, and connective tissue fibers begin to form in the myocardium.
Idiopathic myocarditis of Abramov - Fidler
Another serious non-specific disease. This acute myocarditis has an unclear etiology, which somewhat complicates the process of diagnosis and treatment. In addition, he has a very high mortality rate. It should be noted that relatively healthy, young people are affected by the disease. The average age of patients is 42 years.
The heart muscle of a person susceptible to this disease has serious degenerative, dystrophic and diffuse inflammatory lesions. Cases of widespread cardiosclerosis, intracardiac thrombosis, and embolism of the arteries are frequent.
In many patients, with detailed diagnostics, it is possible to fix the flabbiness of the walls, as well as the extension of the heart cavities and the variegation of the color of the myocardium. In addition, hypertrophy of muscle fibers, extensive fields of myolysis and signs of coronaritis - inflammatory infiltrates along small branches of the coronary vessels are noticeable.
However, this is not all the information you need to know about idiopathic heart myocarditis. That this is, in principle, clear, but it must also be borne in mind that there is a classification. The disease of this type is also divided into four types:
- Dystrophic. The predominance of the processes of hydropic dystrophy of muscle fibers is fixed. in the future they die completely.
- Inflammatory and infiltrative. It is characterized by swelling of the interstitial tissue and its further infiltration by cellular elements.
- Mixed. It is a combination of the above two types.
- Vascular. It is characteristic for him to defeat small branches of the coronary arteries.
After a thorough diagnosis of myocarditis, the doctor will be able to establish its exact type and nature of the course. By the way, sometimes there is a latent form of idiopathic myocarditis, which proceeds without clear symptoms.
Giant cell myocarditis
This is a very rare disease. But it also deserves attention.
The disease differs from others in that the heart muscle begins to collapse immediately, at the first symptoms. And myocarditis complications are also not long in coming.
In many patients, tissue necrosis is already detected at the initial examination, and the test results demonstrate the presence of giant multinucleated cells in large volumes.
It is usually diagnosed in patients aged 20 to 45 years. Most experts are of the opinion that the reasons why this disease occurs are associated with autoimmune processes.
What does it mean? In simple terms, the immune system begins to attack the tissues of its own organism. And cells of abnormal sizes are altered macrophages. That is, once normal cells of the immune system. Initially, they are needed in order to resist inflammatory processes. However, in people with giant cell myocarditis, they degenerate and accumulate in damaged tissues.
Unfortunately, often this disease is asymptomatic. A person may suffer myocarditis and not find out about it, since it often develops against a background of infection, and then its symptoms, accepted by the patient as signs of some kind of flu, disappear after recovery. But the disease itself does not disappear anywhere.
Diagnostics
ECG with myocarditis is the main way by which you can determine the presence of the disease. With its help, it is possible to study the heart rate and rhythm, to learn about the presence of arrhythmias and extrasystole.
The presence of myocarditis is indicated by transient changes in the ST segment, expressed in an increase or decrease in this segment relative to the contour. Often it is possible to detect lengthening of the QT interval and pathological Q waves.
It should be noted that there are no specific tests to detect the disease, but there are markers that indicate damage to the myocardium of the heart. What is this, we will describe in more detail:
- Troponins. These are proteins that take part in the process of contraction and relaxation of the myocardium. If their concentration is increased, then it is damaged.
- Antinuclear bodies. They are a sign of lupus myocarditis.
- Creatine phosphokinase fraction MV. It is an enzyme found in brain tissue, skeletal muscle, and heart cells. Its increased amount also indicates myocardial damage.
- Lactate dehydrogenase. Also an enzyme that determines cell damage. This is a non-specific marker, however, in combination with other indicators, it forms the basis for the diagnosis of the disease.
- Immunoglobulins and circulating immune complexes. They usually indicate the presence of rheumatic heart disease.
Also, with this ailment, the heart rate changes. Everything is individual - in some heart rates it falls below 50 beats per minute, while in others it increases over 90.
To confirm the symptoms of myocarditis, you need to conduct laboratory diagnosis. A study of the composition of the blood will help to identify the cause of its occurrence. With viral myocarditis, for example, there is a decrease in the total number of leukocytes and an increase in lymphocytes.
Often I direct the patient to echocardiography. Using this method, it is possible to evaluate how the heart valves work, in what condition the walls of the myocardium are, how fast the blood moves, whether the systolic function of the ventricles is reduced.
Effects
They are very serious. The worst possible outcome of myocarditis is death. But this is only if the person ignores the passage of medical examinations, is not observed by the doctor and is not treated.
Other effects include dilated cardiomyopathy. This is called an increase in heart muscle in size, and this occurs as a result of a prolonged course of the disease. And in such cases, it is often required not just serious treatment, but a heart transplant.
Most seriously, you need to approach the treatment of giant cell myocarditis. Most patients diagnosed with it require a heart transplant. If transplantation is not carried out, the risk of death increases tenfold. About 90% of patients die within four years.
Preparations
Myocarditis can only be diagnosed by a highly qualified cardiologist. And only he prescribes treatment.
The heart is our main muscle, and experimenting on your own with prescribing drugs is strictly not recommended. This is dangerous, fraught with serious consequences up to death. In addition, there are many types of myocarditis, and only certain medications help to cope with each of them.
But most often, doctors prescribe these medicines:
- Nonsteroidal anti-inflammatory drugs. The treatment of myocarditis with their help is quite effective. These drugs minimize the development of inflammatory factors, significantly reduce swelling. This group includes such well-known medicines as Ibuprofen, Voltaren and Indomethacin.
- Glucocorticosteroids. They are prescribed for the treatment of severe and moderate myocarditis. They have pronounced anti-inflammatory properties. The most popular drug is Prednisone, which is administered intramuscularly. Dosage and duration depends on the condition of the patient, the course can vary from 2 to 5 weeks.
- Antiplatelet agents and anticoagulants. They help prevent platelet sedimentation in blood vessels. Trental effectively corrects these violations. "Heparin" can also be prescribed, which reduces the viscosity of the blood, which is administered subcutaneously.
Mandatory clinical recommendation: myocarditis greatly weakens the state of immunity and health, therefore, it is also necessary to support the work of certain systems with the help of drugs. In particular, to improve metabolism. Metabolic therapy and drugs such as Adenosine Triphosphate, Panangin and Riboxin are aimed at this.
Nutrition specifics
It is important to clarify that a diet with myocarditis is mandatory. Firstly, proper nutrition will help strengthen your heart. Secondly, it helps to improve the metabolism, with which serious problems arise with this disease, as mentioned above.
So, here are the clinical recommendations for nutrition with myocarditis, you need to consider:
- Consume enough protein.
- Enrich your diet with foods containing polyunsaturated fatty acids, magnesium, calcium, and potassium.
- Discard salt.
- Accustom yourself to fractional nutrition - eat at least 5 times a day in small portions.
- Drink low-fat kefir 2 hours before bedtime.
The following foods and dishes will have to be excluded from your diet:
- Everything that excites the heart and central nervous system: black coffee, strong tea, spices, chocolate, energy drinks.
- Smoked sausages, fatty varieties of fish and poultry, meat, kidneys.
- Alcohol.
- Fatty and salted cheeses.
- Grapes, legumes, white cabbage, radish, mushrooms, sorrel, spinach.
In general, everything that is saturated with fiber will have to be excluded from the menu, since it activates the fermentation processes in the intestine, which leads to bloating and negatively affects the work of the heart. And, of course, you need to abandon all fried, canned, salted, smoked, as well as confectionery and fresh muffin.
Folk remedies
Much has been said above about the history of myocarditis, the specifics of its course and symptoms. In the end, it is worth talking about some effective tools that help to cope with the disease, which are good in that they can be prepared on their own. Here are the most popular ones:
- Take 300 grams of walnuts, dried apricots, prunes and figs. Place in a blender and grind coarsely. No need to get trash. It should be a mixture of coarse grinding. It should be poured into a jar and pour liquid honey (should be enough 100-200 ml). Mix everything thoroughly and store in a cool place. Consume this heart-friendly mixture in a teaspoon daily after meals.
- Make on a low heat a decoction of hawthorn and rosehip, mixing 0.5 tablespoons and pouring water (0.5 l). Grind 3 lemons and 200 grams of walnut, prunes, dried apricots and raisins in a blender. Pour the resulting mixture with broth and let it brew for 10 days in an opaque container. The resulting porridge is in the morning, one spoonful on an empty stomach.
- Fill a container of 0.5 l to the top with fresh buds of lily of the valley and pour 70% alcohol. Let it brew for a week, and then strain. Take 60 drops per day, dividing this volume into 3 doses. This tincture has a diuretic, antispasmodic, anti-inflammatory, antiviral, and still soothing effect. It also stimulates myocardial contractility.
- Mix fresh strawberries, its dried leaves and loose black tea. All for 1 tbsp. l Pour boiling water (0.5 L). Insist. Drink like regular tea. This drink is rich in vitamins B1, B2 and B9, nicotinic acid, carotene and ascorbic acid. Helps to eliminate bad cholesterol, normalize salt metabolism and strengthen myocardium.
- Mix valerian root and oregano (2 tbsp. Each), juniper fruits, motherwort herb and fennel (1 tbsp. Each), peppermint and adonis (1.5 tbsp. Each). Brew everything with two glasses of boiling water, bring to a boil and simmer for 7 minutes over low heat. Give a night to infuse, and then drink half a glass 4 times a day. The course lasts 21 days.
And these are just some of the tools that are considered effective. In fact, there are many more, and if you have interest, you can get acquainted with everyone. Many of them are able to eliminate myocarditis pain and improve well-being.