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 should immediately be said that this ailment is dangerous and in the absence of treatment can lead to serious complications. That's why many parents are interested in information about this disease. Why such a malady develops even in infants and what symptoms need to be paid attention? What does the therapy look like and what are the predictions for small patients?

Features and characteristics of the disease

By the term "myocarditis" is meant a disease that is accompanied by an inflammatory process in the cardiac muscle. This ailment 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 tissues of infection and ending with severe allergic reactions and intoxications. Quite often the inflammation covers not only the heart muscle, but also neighboring structures, including pericardium, 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, Coxsackie enteroviruses, as well as parvoviruses, cytomegalovirus, hepatitis and influenza viruses.
• Inflammation of the myocardium sometimes also has a bacterial origin. The disease develops against the background of tuberculosis, brucellosis, bacterial meningitis. Inflammatory process appears when the streptococcal infection is activated.
• The defeat of the body by rickettsia often leads to inflammation of the heart muscle. The risk factors include Ku-fever, typhus, fever of the rocky mountains.
• In the role of pathogen can act pathogenic fungi, in particular, fungi of the genus Candida.
• 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 ingestion of arsenic, mercury, and carbon monoxide into the body.
• Sometimes the ailment develops on the background of taking medications, after vaccination or the introduction of serums.

• The risk factors include snake bites and insects.
• Physical exposure, for example, severe hypothermia, overheating, exposure to ionizing radiation also provokes an inflammatory process.
• Among other risk factors include systemic lupus erythematosus, rheumatoid arthritis and some other autoimmune diseases.

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

Forms and varieties of the disease

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

• If it is a question of the course of the disease, myocarditis can be acute, chronic or subacute.
• Depending on the degree of severity, the ailment can be mild, moderate or severe.
• The doctor pays attention to the clinical manifestations - children can see a typical form of inflammation, as well as worn and asymptomatic.
• The degree of spread of the inflammatory process is also important - in this case, isolated focal (there is an isolated, single site of inflammation) and diffuse myocarditis (the pathology extends to the entire muscle).

How does myocarditis develop in children? The main stages

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

1. Stage viremia - viral particles (or other pathogens) fall into the myocardium. First they are fixed on the surface of muscle cells, and then penetrate into the myocytes. At this stage, the activation of the immune system is observed, which is accompanied by increased synthesis and release of interferon.
2. An autoimmune stage in which the immune cellular response is significantly enhanced and the level of anticardium antibodies that accumulate in the myocardium increases, adversely affecting its functioning. Mediators of inflammation are activated at the same stage . There is damage to microvessels.
3. If the course of the disease is favorable, then there is a reduction in edema and the formation of fibrotic areas on the cardiac muscle. If the therapy did not yield positive results (or was completely absent), the illness turns into a chronic form. With chronic inflammation, complications gradually develop, including heart failure, cardiomegaly, cardiosclerosis.

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

Symptoms of a newborn

Symptoms of the disease depend on many factors - here it is worth taking the age of the child, the origin and form of the disease. The most severe myocarditis in newborns. The kid slowly gaining weight, becomes drowsy and inactive, since even the process of feeding it is very tiring. The skin of the child is pale, often acquires a gray shade.

Another symptom is shortness of breath. First it appears during periods of activity - the baby quickly and heavily breathes during dressing, bathing, defecation, feeding. As the disease progresses, breathing difficulties can already be observed in a calm state. Because of developing heart failure, there are swelling - sometimes they are very pronounced, due to which the weight of the baby increases dramatically. Examination of the child can reveal the 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. The signs of ailment include:

• Pallor of the skin ;
• Fast fatigue, weakness, slight increase in temperature;
• The disappearance of appetite and, correspondingly, a decrease in body weight;
• Soreness in the muscles and joints, and sometimes in the abdomen;
• As the disease develops, children begin to complain of pain in the heart;
• There is shortness of breath and rapid heart rate.

Myocarditis: diagnosis of ailment

With such a disease, the correct diagnosis is of utmost importance. With a child, it is best to contact a pediatric cardiology center. The following procedures are necessary for the diagnosis:

• First, a survey of the child and parents is conducted 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 cyanotic skin, palpitations, swelling and shortness of breath.
• A biochemical and serological blood test is performed, which allows to determine the presence of infection and inflammatory process.
• Radiography of the chest allows the specialist to see the expansion of the heart and the presence of blood stagnation in the vessels of the lungs, which confirms the presence of an inflammatory process in the myocardium.

• Necessarily carried out electrocardiography and echocardiography - these procedures provide an opportunity to examine the work of the heart and assess the extent of violations.
• Myocardial biopsy is indicated only in the most severe cases, since it helps to determine the extent of the inflammatory process.

Treatment of the disease: what do doctors offer?

Of course, therapy depends on the cause and extent of the disease. For example, if there is a bacterial infection, antibiotics are needed, and for viral lesions, the use of antiviral drugs is indicated. Children are also prescribed immunomodulators, which allow to normalize the work of protective mechanisms.

To eliminate the inflammatory process, patients take anti-inflammatory non-steroid drugs (Voltaren, Brufen, Indomethacin). In especially severe cases, steroid hormone drugs are used, which are more effective in controlling inflammation. To eliminate edema, diuretics are used to get rid of excess fluid. It is also important to include in the regimen of vitamin therapy. If it is a chronic process, then a sanatorium treatment is indicated. If there is a persistent arrhythmia that does not lend itself to medical treatment, it may be necessary to implant a pacemaker.

Treatment is carried out in a hospital, it is desirable 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, radiography of chest organs, blood tests should be done periodically - only so you can notice the relapse or the presence of complications in time.

Diet of a child with myocarditis

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

Experts recommend to give up simple carbohydrates - do not give the child a muffin, chocolate, white bread, pasta. You can replace them with baking without yeast. Also, do not abuse salt and spicy foods, fat varieties of meat and fish, rich soups and broths - it is better to eat low-fat chicken fillet and liver (by the way, it is desirable to prepare meals for a couple). Fish is allowed, but only if it is a question of low-fat grades. The number of eggs should also be limited.

In the diet it is necessary to include sour-milk products, fresh fruits and vegetables (except plums, quinces, hard pears and apples, grapes). Chocolate and other sweets can be replaced with honey, jam, marshmallow and marmalade.

Prognosis for myocarditis

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

Among children of school age and adolescents, adverse cases are rarely recorded - as a rule, children quickly recover and return to normal life. True, sometimes during myocarditis in the heart formed sclerotic sites, which can cause heart failure in adulthood.

Prophylactic drugs

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

The state of the newborn should be carefully monitored - infectious and inflammatory diseases should be diagnosed and treated on time. When outbreaks of catarrhal diseases, whenever possible, do not allow the child to contact the infected people. Positively on the state of the immune system will affect proper nutrition, a clear daily routine, moderate physical activity and hardening.