Internal illnesses. Myocarditis (most important)

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Internal illnesses. Myocarditis (most important)

Lecture notes, cheat sheets

Directory / Lecture notes, cheat sheets

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6. MYOCARDITIS

Myocarditis is an inflammatory disease of the heart muscle of an infectious, allergic or toxic-allergic nature.

Etiology. Main factors: bacterial infections, purulent-septic diseases, viral infection, allergic factors, intoxication.

Pathogenesis. Myocardial damage leads to the development of dystrophic-necrobiotic changes in muscle cells.

Clinic. The main clinical variants: pain (not accompanied by heart failure, recovery after 1-2 months), arrhythmic (with severe myocardial damage), circulatory failure (severe diffuse myocardial damage in combination with rhythm and conduction disorders), mixed (pain with arrhythmic, arrhythmic with circulatory failure, etc.), Abramov-Zidler.

The disease begins during the period of convalescence or 1-2 weeks after recovery from infection. An inexplicable low-grade fever appears, rarely - fever, weakness, malaise, sweating. Objectively, tachycardia, low pulse filling, and in severe cases an alternating pulse are noted. In severe cases, the size of the heart increases, blood pressure is normal or reduced. Heart sounds are muffled, splitting of the first sound is possible, a muscle systolic murmur appears above the apex of the heart, and there may be a pericardial friction murmur.

With Abramov-Fiedler's myocarditis, increasing symptoms of progressive heart failure, thromboembolism of the kidneys, lungs, and spleen suddenly appear.

Diagnostic research. A general blood test is performed (leukocytosis, increased ESR). Biochemical study (dysproteinemia, an increase in the content of a- and b-globulins, an increase in the level of sialic acids, the appearance of C-reactive protein, an increase in the activity of AST and CPK in severe forms), a virological study, an immunological study.

An ECG study reveals: ST segment displacement, T wave changes - flat, biphasic, negative, QRST complex expansion, voltage decrease.

Flow. It can be acute, abortive, recurrent, latent, chronic.

Complications. Arrhythmias, circulatory failure, angina pectoris, myocardial cardiosclerosis, thromboembolism.

Differential diagnosis. Should be carried out with neurocirculatory dystonia, coronary heart disease, thyrotoxic myocardial dystrophy, primary rheumatic carditis.

Treatment. Appointment of bed rest. Conducted etiotropic therapy, which is effective in infectious myocarditis, with viral myocarditis is ineffective.

Symptomatic therapy is carried out with cardiac glycosides, antiarrhythmic drugs, diuretics, metabolic agents.

Forecast. With most myocarditis, the prognosis is favorable, with Abramov-Fiedler myocarditis - serious.

Prevention. Primary measures for the prevention of the disease: timely treatment and sanitation of foci of infections. Secondary prevention - dispensary dynamic monitoring of ill persons.

Author: Myshkina A.K.

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