Non-rheumatic carditis in children, as in adults, is heart disease with myocardial damage, the main cause of which is associated with infectious and allergic factors.
Consider all the features of this disease, development in the body, the causes of the onset, symptomatology and diagnostic methods, treatment regimens and prognosis for recovery. Just about important!
Description and prevalence
rheumatic carditis in children often occurs, but diagnose this disease is quite difficult due to the lack of specific criteria for the diagnosis. The clinical picture is variable. On average, half of one percent of all children on hospitalization suffer from non-rheumatic carditis.
The deterioration of microcirculation, the increase in the degree of vascular permeability, which leads to edema of myocardial tissues and the deposition of the immunocomplex , is of great importance in the development of the disease. The development of vascular permeability results in the release of histamine, serotonin, lysosomal enzymes.
Phagocytosis and elimination of viruses end 10 days after the onset of the disease. After 14 days in the heart, they are no longer present. Further, the production of collagen with compaction and transformation into fibrosis, which begins to replace the necrosis areas, is accelerated.
The presence of viruses in the heart for a long period - phenomenon is quite rare .But if this happens, carditis becomes a recurrent type of disease.
After the departure of viruses from the myocardium tissues in the affected cells, a long-term disruption of the exchange of nucleic acids is preserved. Under the influence of pathogens, cells begin to acquire an antigenic character, , while forming certain antibodies .Due to the fact that damaged and healthy cells have the same antigenic character, the emerging antibodies begin to come into contact with healthy cells of the myocardium, having a cross-over character.
This leads to the formation of new autoantigens, which stimulate the production of antibodies. As a result, an autoimmune process begins, leading to the chronic form of carditis .
The immune status of the body also plays an important role in the development of the autoimmune process. As a result of the transformation of viral carditis into an autoimmune process, increases the production of anticardium antibodies and activates the cellular immunity .
Causes of the onset
To the development of carditis most often result in infectious diseases. Myocardial damage can occur as a result of exposure to the body of pathogens such as viruses, fungi, rickettsia, germs .The main factor is considered to be viruses. Great trophy to the tissues of the heart are enteroviruses, rubella, flu, chickenpox.
It is noted that the spectrum of pathogens causing cardiac pathology has a certain dependence on the age of .For example, in the early years, carditis is more likely to develop as a result of the impact of enteroviruses. After five years of age, carditis is caused most often by streptococcal infection. This means that the disease has an infectious origin.
Non-infectious factors are much less likely to lead to myocardial pathology: diffuse pathology of connective tissue, medicinal or food allergies.
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Classification of
There is a definite classification of carditis, although often the cause of the development of this disease remains unclear. Carditis is divided by the period of the onset of the disease on the congenital and acquired .
The nature of the onset of is classified as:
- viral;
- fungal;
- is viral-bacterial;
- is allergic;
- bacterial;
- parasitic.
Localization of the process distinguishes carditis or damage to the conduction of the heart. The course of the disease can be acute, subacute or chronic. By severity, the disease is divided into a light, moderate, severe form. The form of heart failure: left ventricular, right ventricular, total.
For the acute form of is characterized by an acute course, in which cardiovascular failure rapidly develops. Therapy with this form has a fairly good effect. The disease lasts no more than three months.
For subacute form is characterized by a gradual onset and a longer period of recovery, which is often one and a half years. The chronic form of lasts more than a year and a half.
With mild disease, recovery is most often complete .Severe disease leads to myocardial cardiosclerosis, with persistent signs of impaired myocardial function. Inflammatory signs are absent.
Symptomatics and Diagnosis
Suspicion of carditis occurs when a connection is found between the heart and viral infections, allergies, and the use of medications. The acute process of infectious nature most often develops in the first week of the disease. Clinically, heart damage is manifested by inflammatory symptoms.
Symptoms of carditis may be subfebrile temperature( high fever is rare), weakness, increased sweating. There are complaints of tingling in the region of the heart or severe pain. When the myocardium is affected, tachycardia are characteristic, interruptions in the work of this organ, the appearance of dyspnea.
Visually visible blue lips, nasolabial area, increased heartbeat .In severe forms, the pulse is sometimes alternating.
For a mild form of the disease is characterized by a slight change in heart size. The border of cardiac dullness is shifted to the left. In severe form, the heart greatly increases, its boundaries are shifted in all directions. Blood pressure is usually low or normal.
Typically, is defined as heart tone attenuation, 1-tone cleavage. Sometimes 3 and 4 tones are identified with the rhythm of "gallop".This suggests that the tone of the myocardium and its contractile function are reduced. Muscle systolic murmurs are also found. Often, the noise is due to the mitral valve resulting from the prolapse of the prolapse.
Depending on the type of manifestation, myocarditis is distinguished:
- is asymptomatic;
- painful;
- decompensated;
- arrhythmic;
- pseudo valve;
- thromboembolic;
- mixed.
To heart failure, results in a decrease in the contractile function of .It is characterized by shortness of breath, increased veins on the neck, liver size, puffiness.
Laboratory data are not specific to .Usually there are revealed in the analysis of leukocytosis, increased ESR, dysproteinemia, the presence of CRP.Elevated levels of AcAt and CK indicate that there is necrosis of cardiomyocytes, which is more characteristic of severe form. In patients with acute carditis of a viral nature, bacteria and viruses are isolated.
In blood tests of , titres of antiviral antibodies increase, which depends on the type of infection. The immune status is also changed. Anticalardial antibodies are found in the blood.
A significant role in the diagnosis of myocarditis is assigned to the ECG, which can show myocardial damage even with mild disease. Data obtained with the help of echocardiography are not very specific. Usually discoid myocardium, accumulate a small volume of fluid in the pericardium, increase the size of the left ventricle and atrium.
The diagnosis of acute carditis is also confirmed with the method of scintigraphy. With the help of radioactive gallium, inflammatory infiltrates are detected.
Infectious forms, characteristic of small children, are characterized most often by bright cardiac syndrome , often with the appearance of pericarditis, which manifest even earlier than myocardial damage.
For enteroviral pathologies, myocardial damage in combination with encephalocarditis is more typical. Usually, there is always an occurrence of circulatory insufficiency .If this problem is eliminated at the onset of the disease, the dynamics of the improvement in the condition occurs fairly quickly - within three weeks.
With lesions of the myocardial vessels , an obvious increase in heart size is rare .But this species is characterized by a strong pain syndrome. Also, sometimes there are rashes, microhematuria, arthralgia.
If young children have congenital heart defects, this factor makes it even more difficult to establish the correct diagnosis. The causes of overdiagnosis of carditis may be arrhythmias that have arisen as a result of autonomic dysfunction.
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Tactics of treatment
Tactics treatment of carditis in children is as follows:
- destruction of the causative agent of the disease;
- reduction of inflammation;
- restoration of immune reactivity of an organism;
- improvement of the cardiovascular system;
- restoration of metabolism in the myocardium.
If is caused by streptococcal infections of , penicillin, claforan, ampiox is used. To improve the immune reactivity of the body, intravenous immunoglobulins are used for 5 days. To influence the immune system, it is possible to use exogenous interferon-alpha-2, produced in suppositories. It has an antivirus effect.
In severe cases, prednisolone is administered orally for a month. In case of diffuse disease and occurrence of heart failure, glucocorticoids are prescribed.
From diuretics in case of circulatory failure, it is possible to prescribe veroshpiron, triampur in combination with furosemide.
To reduce the load on the myocardium, application of milprinone is indicated. The course is usually short. If there is a tendency to thrombosis, it is advisable to include disaggregants( trental, quarantil) in therapy.
In acute period and with exacerbation, treatment is performed in the hospital. In these periods, physical activity should be limited to 2 weeks. Therapy is aimed at restoring the altered functions of the heart and normalizing blood circulation.
In the diet, the child is prescribed vitamin-rich food with a limited salt content of .The volume of fluid intake is prescribed based on diuresis. With the improvement of blood circulation, the amount of salt and liquid is brought to normal.
Complications and prognosis of
The main complications of carditis are:
- cardiosclerosis;
- myocardial hypertrophy;
- changes in conduction and heart rhythms;
- defeat of valves;
- pericarditis;
- thromboembolism.
When the therapy is started and positive dynamics of the signs of disruption of the myocardium gradually decrease. For mild forms, the prognosis is favorable to .In severe cases, the mortality rate is 80%.
Sometimes carditis can be transformed into dilated cardiomyopathy, which can lead to the need for heart transplantation. Preventative measures to prevent carditis are timely treatment of viral and bacterial infections , prescribed by pediatricians.
