Inflammation of the heart muscle in children. Infectious myocarditis in children: causes, symptoms, diagnosis, treatment. Types of therapeutic therapy

Myocarditis is inflammation of the myocardium (heart muscle). The disease is quite widespread among children of any age, but is more often registered in 4-5 year old children (mainly boys) and in adolescents.

There are congenital and acquired myocarditis. The causes of the development of myocarditis are very diverse and are caused by the influence of various factors.

Infections:

bacterial (with streptococcal infection, meningococcal, diphtheria, tuberculosis, brucellosis, etc.);
viral (caused by enteroviruses, adenoviruses, cytomegaloviruses, influenza viruses, hepatitis, polio, Epstein-Barr, etc.);
fungal (for candidiasis, aspergillosis, actinomycosis, etc.);
spirochetosis (with leptospirosis, Lyme disease, borreliosis);
rickettsial (for typhus, Q fever);
caused by protozoa (malaria, leishmaniasis, toxoplasmosis, etc.).

Worm infestations:

with trichinosis;
cysticercosis;
echinococcosis, etc.

Toxic and chemical factors:

bite of a snake, wasp, etc.;
exposure to carbon monoxide, mercury, arsenic, etc.;
use narcotic drugs and alcohol (in adolescents).

Physical factors:

ionizing radiation;
hypothermia;
overheating.

The impact of some medicines:

antibiotics;
sulfa drugs;
vaccines and serums;
spironolactone, etc.

In addition to those listed, predisposing factors are also autoimmune And allergic diseases.

As can be seen from the above, the development of myocarditis can be caused by any infection, but viral diseases are dominant in children, among which myocarditis is most often caused by adenoviruses, Coxsackie enteroviruses, and influenza viruses.

Of the bacterial infections, myocarditis most often develops in rheumatism, scarlet fever and diphtheria.

Often children also experience myocarditis due to allergic reactions, exposure to toxins, and congenital (developed in utero as a result of infection of a woman during pregnancy). With autoimmune myocarditis, the child’s body produces antibodies to its own heart muscle cells, which destroy the myocardium.

If we consider the cause of myocarditis depending on the age of the child, then early age the disease has a viral, bacterial and toxic origin, and in older age the development of myocarditis is more typical in infectious-allergic diseases.

Autoimmune myocarditis can occur with delayed-type allergic reactions, but can also be an independent disease.

In some cases, the cause of myocarditis cannot be established, and then they speak of idiopathic myocarditis.

Symptoms

A manifestation of myocarditis may be a feeling of discomfort or pain in the heart area.

There is no clinical symptom that would allow one hundred percent accuracy to diagnose myocarditis. Myocarditis in children is characterized by severity and a rapid increase in symptoms.

Clinical manifestations of myocarditis in childhood may differ slightly depending on:

the reasons that caused myocarditis;
depth of damage and extent of spread inflammatory process in the heart muscle;
flow option.

There are such forms of myocarditis:

according to the course: acute, subacute and chronic myocarditis;
according to the prevalence of the inflammatory process: isolated (or focal) and diffuse;
by severity: mild, moderate and severe;
according to clinical manifestations: typical, erased, asymptomatic forms.

Some scientists distinguish, in addition to acute, hyperacute, or fulminant (fulminant) myocarditis, chronic active and chronic persistent variants of the course of the disease.

Inflammation of the myocardium alone is rare. Usually, in addition to the muscle, inflammation spreads to both the inner lining of the heart (endocarditis) and the outer lining (pericarditis). In this totality, changes are found in every third child with myocarditis at an early age. The prevalence of inflammation affects clinical manifestations diseases.

During the neonatal period (4 weeks after the birth of the baby), congenital myocarditis is severe and has the following manifestations: the baby’s skin is pale with a grayish tint; weakness is expressed (the child gets tired quickly during feeding); weight increases very slowly.

Shortness of breath and palpitations first appear during bathing, feeding, defecation, swaddling, and subsequently during calm state.

Swelling may occur. Upon examination, the doctor detects an increase in heart rate and an expansion of the boundaries of the heart. Heart failure appears and progresses over time. Swelling appears and increases, due to this the child’s body weight increases. The liver, and sometimes the spleen, increases in size. The daily amount of urine is reduced.

In infants, myocarditis develops either against the background of a current infection, or a week or more after it. The temperature rises within 37.5° C, and sometimes to high numbers. The skin is pale, with a bluish tint. There is weakness, rapid heartbeat, the child refuses the breast, is capricious, and loses weight.

Myocarditis in infants can begin with shortness of breath. In children after 2 years of age, the initial manifestations may be severe abdominal pain.

The baby's hands and feet are cold. The child is lethargic. The doctor notes an expansion of the boundaries of the heart and an increase in the size of the liver. The child is lagging behind in physical development.

A dry cough may appear. In severe cases of the disease, edema may appear in the alveoli of the lungs; in this condition, the doctor will be able to listen for moist rales. In critical cases, pulmonary edema develops and death is possible.

In older children, myocarditis occurs in acute, subacute and chronic recurrent forms, and has a more benign course. After an infection, myocarditis does not manifest itself in any way for 2-3 weeks.

Then weakness, increased fatigue, pale skin, and some weight loss appear. Body temperature may remain normal or rise slightly. Children may experience pain in muscles and joints, and sometimes abdominal pain.

Children of preschool and school age feel pain in the heart and shortness of breath. Initially, they appear only during physical activity, and subsequently - at rest. Heart pain, although not pronounced, is long-lasting and difficult to relieve with medications.

The child has sleep disturbances, headache, dizziness, increased fatigue, fainting. Some children may experience digestive problems.

An increase in heart rate (and sometimes a decrease in heart rate due to conduction disturbances) and expansion of the boundaries of the heart are observed less frequently. But then there may be a disturbance in the rhythm of cardiac activity, swelling in the lower limbs, enlarged liver.

Idiopathic myocarditis differs in severity.

Diffuse myocarditis is characterized by a greater decrease in myocardial contractility, which is manifested by the development of heart failure. In a focal process, damage to the conduction system is more typical, which is clinically manifested by rhythm disturbances.

Diagnostics

Various methods are used to diagnose myocarditis:

Interview of the child (if age allows) and parents: the doctor finds out and details the complaints, the timing of their appearance, the presence of a previous illness, etc.
Examination of the child allows the doctor to detect pallor and cyanosis of the skin, characteristic of myocarditis; expansion of the boundaries of the heart; heart murmurs; identify increased heart rate and rhythm disturbances; the presence of edema, shortness of breath, wheezing in the lungs; determine the size of the liver and spleen; check the height and weight indicators and their correspondence to the child’s age, etc.
A clinical blood test may show an increase in the number of leukocytes, leukocyte formula indicators, acceleration of ESR, an increase in the number of eosinophils and basophils in allergic reactions.
A biochemical blood test makes it possible to determine the activity of myocardial enzymes and detect C-reactive protein, define protein fractions and etc.
A serological blood test can detect antibodies to the previous day's viral infection.
Electrocardiography (ECG) using the usual method or the method of daily monitoring (Holter method) allows you to detect disturbances in heart rhythm and conduction in the heart muscle.
Echocardiography makes it possible to identify the expansion of the heart cavities, the condition of the heart valves, blood flow speed, etc.
X-ray of organs chest may show expansion of the borders of the heart, stagnation of blood in the lungs.
In rare, difficult-to-diagnose cases, a biopsy of the heart muscle is performed to determine the presence and extent of the inflammatory process in the myocardium.

Treatment

Treatment of acute myocarditis is carried out in a hospital. Strict bed rest is prescribed, the timing of which is determined individually. Bed rest is necessary even in the absence of manifestations of heart failure. In severe cases, oxygen therapy is used.

Treatment of myocarditis should be comprehensive. Specific treatment for myocarditis has not been developed. The main direction is the treatment of the underlying disease that caused myocarditis.

Main Components complex therapy myocarditis:

In the case of a bacterial nature of the infection, use antibacterial drugs: antibiotics (most often used are Doxycycline, Monocycline, Penicillin, Oxacillin).
For myocarditis caused by a viral infection, antiviral drugs are used (Ribavirin, Interferon, Immunoglobulins). Cardio Transfer Factor is often prescribed: an immunomodulator that has no side effects or contraindications. The drug is approved for use from the moment the child is born.

Intravenous administration of gammaglobulin increases the survival rate of children and improves the recovery of myocardial function.

Complex treatment includes anti-inflammatory non-steroidal drugs: salicylates, pyrazolone drugs (Voltaren, Indomethacin, acetylsalicylic acid, Butadione, Methindol, Brufen, Hydroxychloroquine).

These drugs are required in the treatment of myocarditis with a protracted or recurrent course. Some of these medications relieve heart pain. For persistent pain syndrome, Anaprilin can be prescribed in a minimal dosage.

They have powerful anti-inflammatory and antiallergic effects hormonal drugs: glucocorticoids. For severe myocarditis, Prednisolone, Hydrocortisone, Triamcinolone, Dexamethasone are used.

Hormonal therapy is indicated for severe heart failure, pericarditis, and autoimmune myocarditis. The dosage and duration of hormone use is determined individually. During treatment with hormonal drugs, potassium supplements are prescribed, and it is recommended to consume foods rich in potassium (raisins, carrots, dried apricots, etc.).

When heart failure develops after stopping the inflammatory process in the myocardium, digitalis preparations are used under ECG monitoring. In case of severe heart failure, Dopamine and Dobutamine can be used.

For edematous syndrome, diuretics (Hypothiazide, Novurit, Fonurit, Lasix) and a fasting fruit-sugar diet are used.

Complex treatment should include vitamin preparations, especially ascorbic acid and B vitamins. For anxiety, headaches, and sleep disturbances, symptomatic treatment is carried out.

In case of cardiac arrhythmias, antiarrhythmic drugs are selected. For particularly persistent arrhythmias, it is carried out surgical method treatment: transvenous cardiac pacing or implantation of a pacemaker.

For chronic recurrent myocarditis, after a hospital course of treatment, sanatorium treatment is recommended.

Diet

In case of myocarditis, the child should be provided proper nutrition. In mild cases of the disease, it is recommended to limit carbohydrate intake (excluding baked goods, chocolate and limiting pasta, pancakes, pastries). You should not feed your child rich broths, fatty meats, smoked and spicy foods, or pickles.

Even fruits such as grapes, plums, hard pears and apples should not be given to a child with myocarditis.

What can you give? A sick child will benefit from the following products:

lean beef and chicken;
liver;
fish (hake, cod, pollock, pike, pike perch);
eggs (3 pieces per week) in the form of an omelet;
any porridge;
vegetables (carrots, potatoes, cauliflower, tomatoes, cucumbers, beets, parsley and lettuce).

Not prohibited dairy products and milk. You can pamper your sweet tooth with marshmallows, marmalade, honey or jam (if you don’t have allergies). Soft varieties of fresh fruit and dried fruit are also allowed.

Prognosis and outcomes of the disease

With myocarditis, the prognosis depends on the age of the child and the underlying disease that caused myocarditis.

An unfavorable outcome is more often observed in early childhood and in newborns: among them there is a high mortality rate. Even if the child survives, pronounced sclerotic changes develop in the myocardium after the inflammatory process and chronic progressive heart failure, leading to the death of the child.

Bacterial myocarditis often ends in recovery, but viral myocarditis, as a rule, has an unfavorable outcome.

In preschool and school age, myocarditis has a benign course and often ends with complete recovery. In some cases, after the disease, cicatricial sclerotic changes in the myocardium are observed, which can lead to the development of heart failure.

In addition to cardiosclerosis, complications of myocarditis can include pericarditis, thromboembolism, cardiac arrhythmias, dilation of the heart cavities, and heart failure.

Chronic myocarditis in 50% of cases has a recurrent course with the development of chronic heart failure.

Medical examination of children

After myocarditis, children are subject to observation by a pediatrician or pediatric cardiologist. After discharge from the hospital, the child is examined by a doctor monthly for the first 4 months, and then quarterly for a year. After this, examinations are carried out 2 times a year if the outcome of the disease is favorable. Dispensary observation is carried out for 5 years.

An ECG is performed at each examination, and an echocardiogram is performed once a year. If a child experiences shortness of breath, swelling or other complaints, you should immediately contact a cardiologist. If indicated, examinations and examinations are carried out more often.

After suffering from myocarditis, a child should avoid hypothermia, as well as intense physical activity.

Prevention

Knowing what factors contribute to the development of myocarditis, it is necessary to take all measures to prevent their impact on the child. There are quite a lot of such measures:

thorough examination of the expectant mother before a planned pregnancy and prevention acute diseases during pregnancy;
excluding the child’s contact with patients with infectious diseases (bacterial or viral);
planned timely vaccination of the child against “childhood” infections: diphtheria, measles, polio, rubella, mumps;
vaccination against influenza before the seasonal increase in incidence;
timely sanitation of foci of chronic infection in a child (tonsillitis, sinusitis, caries, etc.);
timely contact a doctor if any infection occurs in a child and follow the doctor’s recommendations;
restriction of the child’s physical activity during the period of any infectious disease (even if it is mild) and after viral infections;
compliance with the child's daily routine.

Summary for parents

It is almost impossible to protect a child from all infectious diseases. But it is quite possible for parents to carry out timely and correct treatment of a sick child in order to prevent complications in the form of myocarditis.

Only attentive parents will notice the child’s rapid fatigue during outdoor games, shortness of breath, lethargy, frequent whims, and loss of appetite.

If such symptoms appear in a child, especially after an illness the day before, you should immediately consult a doctor (pediatrician or pediatric cardiologist).

Only timely diagnosis and properly selected treatment for myocarditis can give hope for a favorable outcome and the absence of serious consequences for the child from this terrible disease of the heart muscle.

Which doctor should I contact?

If a child has nonspecific complaints (weakness, loss of appetite, chest pain), you should contact your pediatrician. After the initial diagnosis, he will refer the child to a cardiologist. Depending on the cause of myocarditis, an examination by an infectious disease specialist, allergist, immunologist, or rheumatologist may be required.

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During the diphtheria epidemic in 1990-92, the incidence of myocarditis in children reached up to 60%, with deaths in 20% of cases.

People first started talking about myocarditis in 1837. Myocarditis can be either an independent disease or a complication of an infectious pathology.

If we talk about the frequency of occurrence among all cardiovascular diseases, then myocarditis accounts for up to 11% of cases among the pediatric population.

Shkolnikova M.A., professor: “Diagnosis of myocarditis is complicated by the fact that it is asymptomatic; this disease is predominantly of childhood.”

Causes of myocarditis

Viruses.
Bacteria.
Infectious factors.
Allergic components.
Systemic diseases.

In more than half of cases, myocarditis is caused by viruses. In recent years, the predominance of adenoviruses in children has been revealed.

In young children, enteroviruses, adenoviruses, and herpes simplex virus play a predominant role. If during pregnancy the mother suffered any infection, you should be very careful about the baby’s heart muscle.

If we talk about the bacterial cause, then diseases such as diphtheria, scarlet fever, tuberculosis, and salmonellosis prevail here.

Also, myocarditis in children can occur after burns, internal organ transplantation, drug poisoning, bronchial asthma.

Classification

In 1998, a classification was adopted according to which there is the following division of myocarditis:

rheumatic carditis in children;
non-rheumatic carditis.

Then myocarditis became divide by flow:

spicy. Lasts up to 6 weeks;
subacute Duration up to 6 months;
chronic active. The disease lasts more than 6 months;
chronic persistent. Chronic course with periods of remission and exacerbation.

By time of appearance:

congenital;
acquired.

By form:

focal;
diffuse. Affects almost the entire myocardium.

Professor Belokon N.A. in 1984 - 85 used the term “carditis”. It was believed that inflammatory diseases hearts affect all the linings of the heart, and it would not be rational to subdivide them. But in 2010, the Association of Pediatric Cardiologists of Russia proposed using the term “myocarditis”.

What is myocardium?

The heart has three membranes - the endocardium (inner), myocardium, epicardium, and the pericardium. They are all located close to each other, so any inflammation in one membrane can affect the other.

In general, the myocardium is essentially a muscle. One of its important functions is to create heart contractions. Its main part is formed by cells called cardiomyocytes, or myocardial cells.

In these cells there are special areas - sarcomeres, which have light and black stripes. The essence of the work of these cells is aimed at ensuring that an electrical impulse can easily pass through them and contract the myocardium.

It should be borne in mind that the muscle tissue of the atria and ventricles is separated by a septum, due to which they contract at different times.

General symptoms of myocarditis

The appearance of myocarditis is always associated with a previous infection. Complaints arise 1 - 2 weeks after a viral or bacterial attack. Myocarditis can occur either asymptomatically or lightning fast with rapidly increasing heart failure and pulmonary edema.

Highlight Variants of the course of this disease:

cardiac;
abdominal;
respiratory;
hypoperfused.

The respiratory variant is observed in most children. Characterized by the appearance of shortness of breath. The doctor may listen for wheezing. As a rule, a child with such complaints is treated for tracheitis or bronchitis. The cardiac variant can be noted in older children, who may subjectively complain of pain in the heart area.

Hypoperfusion means that the heart muscle cannot cope with its work, as a result the pumping function of the heart is impaired and cardiac output decreases. This can lead to arrhythmia, fainting and seizures.

Abdominal option. From the Latin abdomen - belly. Characterized by abdominal pain. Again, this is due to poor circulation and low cardiac output, and as a result, other organs begin to suffer.

Congenital myocarditis is manifested by heart failure and an increase in the size of the heart, which is detected in the womb or a few days after birth. As a rule, the mother of such a child has suffered some kind of infectious process. But also, congenital myocarditis cannot be excluded in a child under six months old if he does not have any diseases with foci of infections.

Pericarditis in children (inflammation of the pericardial sac) is characterized by the appearance of effusion between the layers of the pericardium. As a result, the pericardial layers thicken, and a “shell heart” may occur. Pericarditis in children threatens the rapid development of heart failure, since the inflamed pericardium compresses the outside of the heart chamber and prevents them from contracting fully.

CLINICAL CASE. A 5-year-old child suffered from ARVI. Adenovirus infection With high temperature, was getting antiviral treatment 5 days. 2 weeks after recovery, the boy began to get tired during normal outdoor games. At the appointment, the pediatrician listened to a heart murmur and sent me for a heart ultrasound. As a result of this examination, a diagnosis of “focal inflammatory changes in the myocardium, myocarditis” was made. The child was immediately hospitalized. In the hospital he received antibacterial therapy; after 14 days, upon re-examination, residual inflammatory foci remained.

Infectious-allergic myocarditis in children

Develops against the background of chronic foci of infections - sinusitis, otitis, tonsillitis. Also, there is a burdened allergic background, the presence of diathesis, asthma, hay fever, and drug intolerance.

The trigger for development is a previous infection or exacerbation of a chronic pathology.

The main symptom of this disease is pain in the heart area, both at rest and after exercise. But in most cases, infectious-allergic myocarditis can be asymptomatic. Myocarditis generally ends favorably.

With persistent chronic infection, myocarditis can cause relapses (exacerbations).

Rheumatic carditis in children

Rheumatism is one of the manifestations of the disease. This pathology is caused by streptococcus and appears after a sore throat or scarlet fever.

Inflammation of the heart will always be accompanied by a fever of up to 40 degrees.

“Rheumatism licks the joints, bites the heart.” This suggests that rheumatic disease may also cause arthritis.

The clinical picture of rheumatic carditis may be characterized by pain in the heart area. It can also be effusion, that is, it occurs with the appearance of liquid between the membranes. Also, with increasing inflammatory changes, manifestations of heart failure:

dyspnea;
increased heart rate;
pain in the heart area.

Rheumatic carditis requires complex therapy with the use of penicillin antibiotics.

Diagnosis of myocarditis

General blood and urine analysis.
Biochemical tests. There are characteristic markers of myocardial damage (Troponin, Creatinine phosphokinase (CPK MB), Lactate dehydrogenase (LDH)). These enzymes appear in the blood in increased quantities when inflammatory changes occur in the heart.
Biochemical blood test (acute phase proteins, rheumatoid factor if rheumatism is suspected).
Antistreptolysin. Indicates the presence of waste products of streptococcus in the blood.
Bacteriological blood culture.
A chest x-ray will help clarify the size of the heart and changes in its shape.
Electrocardiography.
Echocardiography. The most important thing. With its help, it is possible to determine the functioning of the left ventricle and detect signs of heart failure at an early stage.
MRI (magnetic resonance imaging).
Invasive research methods - taking a myocardial biopsy, cardiac catheterization. It is carried out in specialized cardiac surgery centers.

Treatment of viral and other types of myocarditis

Treatment of myocarditis must be comprehensive, in a hospital setting.

It is based on eliminating the cause that caused myocarditis - a virus, bacteria, or other infectious process.

Bed rest. But it is required breathing exercises to maintain the functioning of the heart muscle.
Complete balanced nutrition.
Drink under the control of urine excretion per day to prevent swelling.
Antibacterial therapy. A number of cephalosporins and penicillins are used more often for streptococcal infections. Duration 2 - 4 weeks, preferably with intravenous or intramuscular administration.
Antiviral therapy. It all depends on the pathogen that caused myocarditis. If herpes infection - Acyclovir, CMV infection - Cytotect.
Symptomatic therapy heart failure with the use of diuretics, cardiac glycosides.
Interferon preparations. As a rule, they are used for viral, viral-bacterial myocarditis.

Prevention

1. Primary prevention:

prevention of intrauterine infections, their timely detection and treatment
immunoprophylaxis of infections;
extension National calendar vaccinations;
seasonal prevention of influenza and ARVI;
hardening the child;
sanitation of foci of infection;
timely treatment of caries, tonsillitis.

2. Secondary prevention. Correct dispensary observation and rehabilitation of those cured of myocarditis. Adequate treatment of children with mild clinical forms of myocarditis.

Infectious myocarditis is a serious disease with severe complications. But if you pay close attention to your child and do annual examinations, at least minimal laboratory and instrumental examinations, you can avoid this problem.

A pediatrician should always be wary of frequently ill children with chronic infections and timely referral to a pediatric cardiologist.

More than 50% of myocarditis cases among children of different ages, observed in children 4-5 years old. The reasons why this happens are the influence of bacteria, viruses, exposure to drugs, hypothermia, and insufficiently stable immunity. Who is to blame for this and why does this happen?

Pediatric myocarditis: features and dangers

Myocardium is the cardiac muscle that makes up the bulk of the heart. Its parenchyma includes a huge number of cardiomyocytes, which are damaged during an attack by infectious microorganisms. And this is the main cause of heart problems in infants and schoolchildren. The age of 4 years sometimes becomes critical for children, because at this time, according to statistics, they are especially susceptible to such complications.

The disease in children may be accompanied by severe symptoms, which brings real suffering to kids who cannot even understand and express their pain in order to convey this information to their parents.

The signs that are observed in pathology (lethargy in the child, reluctance to play, increased tearfulness and loss of appetite) may mean simple indigestion, and the mother never thinks that the child has heart problems. The treachery of the disease lies in the fact that it cannot be recognized for sure. After all, he doesn't have specific symptoms, except for rapid heartbeat and shortness of breath, which directly indicate the cause of deterioration in health.

Classification

Just like in adults, childhood myocarditis is divided into types according to its origin. And first of all, this is a disease that developed due to a congenital predisposition, or the result of infection.

Considering the type of inflammatory process, and, accordingly, the changes that it entails, it is divided into:

dystrophic appearance arising due to lack of tissue nutrition;
vascular when they are destroyed along the way blood vessels organ;
inflammatory-infiltrative nature with fibrous growth of connective tissue and the formation of scars on the organ;
necrobiotic – with the death of myocardial cells and atrophy of the heart muscles.

And since the nature of the process is diverse, there is also a combined type that can combine all the symptoms of other manifestations.

According to its course, childhood myocarditis can be defined as:

first stage– manifestation of symptoms due to the presence of the pathogen and associated poisoning of the body;
second stage– allergic response to infectious interference;
third stage– a degenerative process that logically occurs against the background of such inflammation;
fourth stage– sclerosis of myocardial tissue, occurring as a result of pathology.

According to its symptoms, myocarditis in children can:

have no obvious symptoms;
accompanied by pain (pseudocoronary);
thromboembolic, if it is accompanied by blood viscosity and the formation of blood clots;
arrhythmic with characteristic disturbances in heart rhythm;
pseudovalvular, that is, indicating valve dysfunction;
decompensation with persistent circulatory disorders.

Finally, the disease can progress through different scenario, and therefore, there are types that differ in the severity of the abnormal process: mild, moderate and severe forms of the disease. This is due to the fact that myocarditis can be acute, subacute and chronic, which means progressive progression, episodes of quiescence and relapse.

Reasons why heart pathology develops

Prerequisites that lead to the disease:

Non-infectious factors influencing myocardial damage:

childhood myocarditis can be a consequence of an allergic process, when the child’s immune system incorrectly evaluates its own tissues as a foreign protein - this is medicinal compositions: cytostatics, antibiotics, bacteriostatic drugs (aminosalicylic acid), antipyretic antipyretics and analgesics;
allergic reactions of the body to thyroid hormones, adrenal tumors, poisoning, broad-spectrum drugs;
destruction of the walls of blood vessels;
rheumatoid type arthritis;
connective tissue pathologies;
exposure to radiation, living in an unfavorable area.

Often, inflammation of the heart muscle in children occurs against the background of infection with enteroviruses, the causative agent of influenza, and bacteria - the culprits are diphtheria, rheumatism and scarlet fever.

Regarding age, young children are more susceptible to the infectious and allergic components of the disease separately, while older children are faced with a simultaneous combination of these types.

When the genesis remains unknown, despite careful examination, the diagnosis sounds like idiopathic myocarditis.

Symptoms of the disease

It is important for parents to understand what symptoms may be typical for early stages myocarditis, in order to take urgent measures and stop the course of the disease as early as possible.

In newborn babies, these are external, unnatural signs that are not typical for babies:

pale, waxy skin;
the child holds his breath during sleep;
even with minor movements the baby experiences shortness of breath;
the baby gets tired of suckling;
lack of weekly weight gain;
the pulse quickens, and the heart makes a dull sound and seems to stop.

These are alarming signs that need to be responded to immediately and the baby taken to the pediatrician.

As a rule, these are symptoms of congenital myocarditis, but the disease also occurs in a naturally healthy child due to viral and bacterial complications.

Manifestations of the acquired form of the disease can be more pronounced:

such children lose their appetite;
they constantly cry, get nervous, and can be capricious;
sometimes there are attacks of nausea, turning into vomiting and all the signs of toxic poisoning are evident;
mood changes often occur;
weakness and shortness of breath occur;
fainting occurs;
Children experience sleep disorders and lose interest in games and exploration.

Parents, especially expectant mothers, should know that infection of a child can occur during its intrauterine development, during pregnancy. Then the first symptoms will appear very soon - almost immediately after the baby is born, a few weeks later. Such a lag in development is difficult not to notice, because the baby, in fact, stops growing, his breathing is difficult and accompanied by shortness of breath, and his arms and legs may swell.

In such a situation, in no case should you treat the child yourself - if done incorrectly, the disease can seriously worsen and aggravate the already serious condition of the baby.

In children aged 2-3 years, in addition to the listed signs, myocarditis is accompanied by abdominal pain, the limbs are almost always cold, wheezing appears during breathing, and a cough may develop - this is a dangerous condition that threatens pulmonary edema and the death of the baby. Such children have an enlarged liver and greatly expanded heart chambers, which can be clearly seen during an instrumental examination.

In adolescents aged 10-14 years, the condition with myocarditis is not as severe as in infants. However, they seriously suffer from heart pain and analgesic drugs cannot always relieve them. In addition, schoolchildren often have headaches, problems with digestion of food, rapid heartbeat, and often loss of consciousness.

These are all symptoms serious illness, and requires diagnosis and urgent treatment.

Diagnostics

Laboratory and hardware methods are used to identify the disease, but it all starts with an examination by a therapist or cardiologist. If the child is small, the doctor finds out the circumstances and events preceding the disease that could cause the onset of myocarditis in the baby, as well as in the mother if the newborn is sick.

A visual examination allows you to understand how far the disease has progressed - this can be judged by the bluish tint of the skin; when listening, wheezing and noise in the organ are detected. Frequency is also determined heart rate, the presence of signs such as swelling, heavy breathing, shortness of breath. The doctor can examine how important the larger than normal size is. internal organs- spleen and liver. This is done taking into account the age of the small patient, his height and weight.

Other research methods:

a blood test (general, extended) is needed to obtain information about the state of leukocytes, erythrocytes, to confirm the inflammatory process;
a serological blood test is required - detected antibodies can give an idea of the previous infection;
Among the instrumental methods, electrocardiography is used to record disturbances in the heartbeat and muscle conduction;
X-ray and echocardiography show how dilated the chambers of the heart are, its boundaries, the speed of blood movement and the places where it stagnates.

If clinical picture disease and after this remains unclear, a heart biopsy is used, when organ tissue is taken for microscopic examination. This way the degree of damage is scanned and the focal or diffuse form of myocarditis is determined.

Diagnosis in children can provide the following data characteristic of the disease:

expanded boundaries of the organ;
the left atrium and left ventricle are enlarged in volume;
there is atrioventricular block (a clear disturbance of cardiac conduction).

Since a dangerous pathology can negatively affect the child’s condition and pose a threat to his life, treatment should begin immediately after diagnosis.

Treatment of childhood myocarditis

Therapy is carried out in the hospital with bed rest, since this disease requires restriction of the motor activity of the sick child for at least two weeks.

There is no specific technique for eliminating myocarditis, but treatment is always aimed at the cause of the disease.

Complex therapy includes several important points:

When diagnosing an infectious type of disease, antibiotics from the penicillin group, tetracyclines and antiviral drugs are used.
the list of medications includes non-hormonal anti-inflammatory drugs - salicylates (Aspirin in small doses to improve blood microcirculation);
pyrazolone drugs (Phenylbutazone, Butadione - to relieve inflammation, pain, fever);
antimalarials (Hydroxychloroquine - helps prevent the formation of fibrous tissue in the heart in a diffuse form, reduces the allergic response of the immune system, has anti-inflammatory properties);
with strong pain Anaprilin (tablets) is prescribed, used in minimal dosages, at the same time, it has a hypotensive effect, improves the condition of blood vessels, and prevents arrhythmia.
hormonal drugs - glucocorticoids are necessary when a strong anti-allergic and anti-inflammatory effect on the tissues of the diseased organ is needed and when heart failure occurs, in these cases Hydrocortisone (injections, tablets) is used, the drug reduces the permeability of the heart vessels, delays organ hypertrophy caused by the growth of fibroblasts, suppresses allergic body reactions, similar medications are also used - Prednisolone, Dexamethasone;
when there is insufficient blood supply, cardiotonics are used. Dopamine (used intravenously) supports and tones the myocardium and other layers of the heart, stabilizes blood pressure, has a diuretic effect for edema; for such symptoms, other drugs are also effective - Fonurit, Hypothiazide, Novurit;
The treatment complex includes vitamin therapy - potassium, magnesium and calcium preparations, vitamins B and C.

Even if there are no symptoms of heart failure, bed rest is prerequisite in the treatment of myocarditis in children and adults.

Children are prescribed a diet with limited carbohydrates - sweets, baked goods, pasta, fatty foods, spicy, salty foods.

Unfortunately, some fruits are contraindicated for a child - hard apples, pears, grapes, plums.

Sick children benefit from porridge, vegetables, lean boiled meat, liver, dairy products, herbs, honey, and dried fruits.

Infectious myocarditis

A child’s body can attack many pathogens, including dangerous viruses and bacteria.

The peculiarity of the viral effect on the child’s heart is its direct penetration into the myocardial cells, where it immediately begins its subversive activities, in particular, replication. It is in this first phase that it is advisable to perform a biopsy of cardiac tissue to isolate the type of agent.

When the inflammatory process drags on and turns into chronic stage, the body’s immune response often follows, aggravating the situation - as a result, rapid damage to the heart occurs, and in the final stage - fibrotic changes in tissue.

Medicines that can help in this case:

Antibiotics – Penicillin, Oxacillin, Monocycline. Doxycycline is mainly used in tablets and solution for intravenous administration - it has a bacteriostatic effect, suppresses the viability of microbes and stops the process of their reproduction. In children, this drug is used due to its gentle effect on digestive tract, beneficial intestinal flora. Important correct dosage, since exceeding it can cause side effects such as nausea, vomiting, and bowel movement disorders.
Antiviral agents – Interferon, Ribavirin. Gamma globulin is prescribed as a solution for intravenous injection. The medication contains globulin proteins, which contain antibodies that are active against many viruses. These substances are especially effective in treating infections in children.

After recovery, children should periodically (every three months) undergo a medical examination; this situation persists for at least 5 years in order to prevent complications and re-damage to the heart muscle.

Prognosis and complications

The consequences of childhood myocarditis can be myocardial sclerosis, when connective tissues grow and form a rough scar, which causes disruption of the functionality of the organ. In addition, inflammation can involve the outer and inner muscle layers and lead to pericarditis and endocarditis. The result is always the same - heart failure and circulatory pathology of the whole body. In half of the situations, this is caused by an advanced disease, its chronic form.

The poor prognosis mainly concerns newborns, and the percentage of deaths is still high among them. Sclerotic changes that remain in infants can provoke various heart diseases in the future.

Children of preschool and school age tolerate the disease more easily and, as a rule, fully recover with timely treatment.

It has been noted that bacterial myocarditis has a milder course, but the viral type has every reason to be considered more dangerous and lead to complications and even the death of the baby.

Prevention of myocarditis in childhood

On the part of parents, it is necessary to take all measures to prevent complications that are the causes of myocarditis in children.

The expectant mother, already at the planning stages of pregnancy, monitors her health, and if there are any diseases, chronic and infectious, cure them completely;
during pregnancy, a woman should not be allowed to suffer from acute, especially infectious, illnesses;
children should be protected from unnecessary and dangerous contacts with sick peers and other people who may be infected;
it is important to get vaccinated on time and get vaccinated in case of any epidemic;
it is noted that myocarditis is often a consequence of diseases of the nasopharynx; special attention should be paid to this factor;
if the baby is sick, he should under no circumstances endure the illness on his feet - a visit to the doctor and bed rest are required, otherwise these are already known complications for various internal organs;
children should eat normally; the quality of food largely determines the state of their immunity, so vitamin deficiency and nutritional deficiencies should not be allowed;
It is important that the child has a certain daily routine, in which physical and mental stress will be evenly distributed - study, games, rest, sleep.

It is impossible to completely protect children from all dangers, but attention and constant monitoring of the health and mood of your child can provide invaluable assistance in identifying the preconditions for myocarditis. The main thing, at the same time, is not to try to treat the baby yourself, even with tried and tested grandmother’s recipes - this was and remains the lot of doctors.

Myocarditis is a congenital or acquired inflammation of the heart muscle (myocardium). The disease can affect the myocardium in children of any age; children aged 4-5 years are most susceptible to it. Girls get sick less often. It is difficult to establish the exact prevalence of myocarditis among children, since in 25-30% of cases the disease is asymptomatic.

Causes

The development of myocarditis can be provoked by any infections suffered by the child, in particular, sore throat, scarlet fever, pneumonia, the causative agent of which is often streptococcus.

The causes of myocarditis vary widely:

Most often, the provoking factor is infection - myocarditis can occur with any infectious disease.

The causative agents may be:

bacteria for infections such as: diphtheria, scarlet fever, tuberculosis, tonsillitis, pneumonia, brucellosis, rheumatism, meningococcal infection, etc.;
viruses – causative agents of diseases such as influenza, polio, mononucleosis, hepatitis, chicken pox, measles, etc.;
fungi (candida, aspergillus, actinomycetes, etc.);
spirochetes (Borrelia, Leptospira);
rickettsia (causing typhus, Q fever);
protozoa (Toxoplasma, Leishmania, Plasmodium falciparum).

Inflammation of the heart muscle can be caused by helminths (Trichinella, Echinococcus, Cysticercus, etc.).
Myocarditis can develop due to the action of chemical factors or toxic substances:

snake venom or insect bites;
inhalation of mercury vapor;
poisoning carbon monoxide;
alcohol or drugs (in teenagers).

Physical factors can provoke the occurrence of myocarditis: high or low temperature, radiation exposure to the body, etc.
Side effects of certain medications: serums, vaccines, some sulfa drugs and antibiotics, etc.
Allergic reactions (delayed type) and diseases.
Autoimmune diseases in which antibodies are produced that destroy the fibers of the heart muscle.
Systemic diseases (rheumatoid arthritis, scleroderma, systemic lupus erythematosus).

The cause of congenital myocarditis in an infant may be an infection suffered by the mother during pregnancy and intrauterine transplacental infection. The most common causative agent of this infection is the Coxsackie virus. In newborns, in this case, manifestations of myocarditis are combined with damage to the liver or brain.

The dependence of the cause of myocarditis on the age of children is also visible. Thus, in young children, the causative agents of the disease are usually viral (more often) or bacterial infections, toxic effects. In adolescents and older children, myocarditis is often of infectious-allergic origin.

Classification

In addition to infectious myocarditis, idiopathic myocarditis occurs. It is diagnosed when the cause of the disease has not been established.

Depending on the course of myocarditis, it can be:

sharp;
fulminant (fulminant);
chronic active;
chronic persistent (with periodic exacerbations).

According to the prevalence of the process, the disease can be isolated (focal) or diffuse. Based on severity, myocarditis is classified into mild, moderate and severe.

Development mechanism

The stage of viremia or bacteremia (spread of the microorganism through the bloodstream) lasts up to 3 days. With the blood, the pathogen enters the muscle tissue of the heart, attaches to muscle cells, and then penetrates inside the cells. This causes activation defense mechanisms and an increase in interferon synthesis.

At the same time, anticardiac antibodies are actively produced, which are fixed on myocardial cells and cause necrosis of muscle fibers. At the same time, blood vessels are damaged, which leads to disruption of microcirculation. Exudate sweats through the deformed vascular walls.

With an unfavorable course and chronicity of the process, the following gradually develop:

cardiomegaly (enlarged heart size);
sclerotic changes in the myocardium;
heart failure progresses;
dilated cardiomyopathy occurs (increase in the volume of the heart cavities).

Isolated myocardial damage develops in rare cases. More often, inflammation also affects the outer (pericardium) or inner (endocardium) lining of the heart. Such widespread inflammation develops in 30% of cases. Simultaneous inflammation of all the membranes of the heart is called “pancarditis”.

Symptoms

Pale skin, unreasonable anxiety, bad dream the child may show symptoms of myocarditis.

Clinical manifestations of myocarditis depend on its cause, the age of the child, the nature of the course, the prevalence and depth of myocardial damage. Symptoms of heart damage may occur several days after the initial infection or several weeks later.

A feature of the clinical manifestations of myocarditis in children is the acute onset, severity and rapid increase in symptoms.

Congenital myocarditis manifests itself in the first weeks after birth and is severe.

Its symptoms are:

pallor and grayish tint of the skin;
weakness (the baby gets tired even when feeding);
poor weight gain;
increased heart rate and breathing (shortness of breath) appear first with the slightest exertion (during bathing, feeding, changing clothes, defecation), and over time at rest;
restlessness and poor sleep;
swelling may occur;
the appearance and progression of heart failure.

A doctor, examining a child, may detect an expansion of the borders of the heart and an enlarged liver. The amount of urine excreted per day decreases.

In infants, myocardial inflammation can occur both during infection and several days after it. Initial symptom there may be shortness of breath or a rise in temperature to 37.5 ° C (but fever with higher values is also possible).

Characteristic symptoms are also:

pallor;
increased heart rate;
weakness;
weight loss;
breast refusal.

In some children, the disease may begin with collapse: loss of consciousness for a short time, the body becomes covered in cold sweat, and convulsions are possible.

In preschool age children, the disease may begin with abdominal pain and possibly loose stools.

Symptoms of the disease may also include:

lethargy;
dry cough;
shortness of breath, first with exertion, and then at rest (respiratory rate can reach 60-100 in 1 minute);
groaning breath;
heartache;
liver enlargement;
pallor, acrocyanosis (blueness of the lips and nail phalanges of the fingers);
limbs cold to the touch;
fainting and dizziness;
frequent headaches;
poor sleep;
developmental delay;
rapid fatigue after light exertion.

Due to severe shortness of breath, children take a forced position - reclining or sitting. And although an increase in the boundaries of the heart and an increase in heart rate are less common, different types of rhythm disturbances (arrhythmias) may occur. In severe cases, pulmonary edema is possible with an unfavorable outcome.

At older ages, the course of the disease is more benign. It manifests itself after an infection, usually at intervals of 2-3 weeks with the following symptoms: weakness, fatigue, severe pallor. Abdominal pain, joint or muscle pain are noted. The temperature rises slightly or remains normal.

Idiopathic myocarditis has a severe course. The focal process often manifests itself as arrhythmias due to damage to the conduction system. With diffuse inflammation of the heart muscle, the contractile function of the myocardium suffers more, which causes heart failure with stagnation in the systemic or pulmonary circulation.

Diagnostics

Many methods are used to diagnose myocarditis:

When interviewing parents or the child himself, the doctor details the complaints, receives information about the illness suffered the day before, the dynamics of the development of the pathology, and other data.
Examining the patient, the doctor identifies pallor and acrocyanosis, fever, determines the pulse and respiratory rate, the boundaries of the heart, blood pressure, liver size, edema, and listens to the heart and lungs.
Blood test:

clinical – signs of inflammation (increased leukocytes and accelerated ESR) or an allergic reaction (increased eosinophils) may be detected;
biochemical study to determine the activity of myocardial enzymes, C-reactive protein, and other indicators;
serological analysis to detect specific antibodies and confirm the viral nature of a previous infection.

An ECG reveals conduction disturbances, arrhythmias, and metabolic changes in the myocardium. Sometimes 24-hour Holter monitoring is used (ECG recording continuously throughout the day with a special device).
Echocardiography (ultrasound of the heart) detects structural changes in the heart (dilation of the cavity, defects), the presence of fluid in the heart sac, blood flow speed and other functional indicators.
Chest X-ray reveals an enlarged heart and signs of congestion in the lung tissue.
In diagnostically difficult and severe cases, endomyocardial biopsy may be prescribed - invasive method diagnostics to determine the nature and extent of the process.

Treatment

Children with acute myocarditis are subject to hospitalization in a hospital with bed rest until their condition improves.

Children with acute myocarditis are treated in a hospital. It is mandatory for the child to remain in bed for about 2 weeks (the duration is determined individually).

No specific therapy has been developed for myocarditis. The main task is to treat the underlying disease that caused myocarditis. In addition, symptomatic therapy is prescribed.

Components of complex treatment are:

oxygen therapy for severe disease;
antibiotics for a previous bacterial infection (Oxacillin, Penicillin, Augmentin, Ospamox, Minocycline, Doxycycline, etc.);
antiviral agents in case of viral infections (Interferon, Ribavirin, Immunoglobulin); with intravenous administration of gammaglobulin, the functional recovery of the myocardium increases and the prognosis for patients is more favorable;
non-steroidal anti-inflammatory drugs (Voltaren, Ibuprofen, Butadione, Brufen, Indomethacin, etc.);
corticosteroid hormones (in severe cases): Prednisolone, Dexamethasone, Hydrocortisone, Triamcinolone;
for heart failure, digitalis preparations are prescribed after the inflammation in the heart muscle has stopped;
for edema, diuretics are prescribed (Lasix, Hypothiazide, Furosemide, Novurit, Trifas);
vitamin therapy (from group B, vitamin C);
for persistent pain, minimal doses of Anaprilin are used;
If the rhythm is disturbed, the cardiologist will select antiarrhythmic drugs.

In case of persistent arrhythmia and ineffectiveness medications it is possible to carry out radical surgical treatment– a pacemaker is implanted or transvenous cardiac pacing is performed.

In case of chronic myocarditis with relapses, it is advisable to continue treatment in a sanatorium after hospitalization.

Diet therapy

In case of myocarditis, it is necessary to pay attention to the child’s nutrition. It is better to cook dishes by steaming. Small portions should be given to the child 5-6 rubles. in a day.

The following products are allowed:

meat (beef, chicken);
fish (low-fat varieties);
porridge (any);
fermented milk products (yogurt, kefir, cottage cheese, fermented baked milk, sour cream);
vegetables (stewed, boiled): carrots, cauliflower, potatoes, lettuce, cucumbers, beets, tomatoes, parsley;
chicken eggs in the form of an omelet (3 pieces per week).
dried fruits and fresh fruits of soft varieties (excluding plums, grapes, quinces, hard pears and apples).

Children with a sweet tooth are allowed jam, honey (in the absence of allergies), marmalade, and marshmallows.

You should limit your consumption of chocolate, baked goods, pastries, pancakes, and pasta.

The following are subject to exception:

spicy and fried foods;
fatty meat (pork, goose, lamb, duck) or fish;
rich broths;
pickles;
smoked meats;
seasonings;
carbonated drinks.

If you have edema, you need to limit your salt intake (no more than 6 g/day), as it will retain water in the body and increase the load on the heart.

When treating with corticosteroid drugs and diuretics, it is necessary to consume foods containing potassium (raisins, carrots, dried apricots, cucumbers).

Forecast

Steamed lean meat will replenish the body of a child with myocarditis with protein and will not harm his heart.

The outcome options for myocarditis depend on the nature and extent of the inflammatory process in the heart muscle, the age of the child and the state of the immune system.

The outcome of the disease can be:

sudden death;
dilated cardiomyopathy;
heart failure;
cardiosclerosis;
thromboembolism;
arrhythmias;
recovery.

The prognosis of myocarditis in young children and newborns is especially serious - among them the mortality rate remains high. Bacterial myocarditis often has a favorable outcome, while viral myocarditis usually ends in death.

In older children timely diagnosis And proper treatment a favorable outcome is possible. With mild severity, children more often recover without impairment of heart function.

Dispensary observation

A child with myocarditis is subject to observation by a pediatric cardiologist (or pediatrician) for at least 5 years. After a treatment course in a hospital, a medical examination is carried out monthly (4 months), then once a quarter for a year, then twice a year. Monitoring ECGs are performed at every visit to the doctor, and echocardiography is performed annually. It is necessary to exclude hypothermia in children and significant physical activity (the child is transferred to a special physical education group).

Prevention

Preventive measures are aimed at eliminating factors that can cause myocarditis in children.

These include:

examining a woman before a planned pregnancy and excluding infections during pregnancy;
maximum exclusion of contacts of children with infectious patients;
timely (according to the calendar) professional vaccinations for the child;
flu vaccination when there is a threat of an epidemic;
treatment of existing foci of infection.

Summary for parents

Myocarditis is severe in young children and can leave behind serious cardiac dysfunction. That is why parents should take a serious approach to the treatment of viral respiratory diseases, sore throat, pneumonia, which children are so often susceptible to and which can cause myocarditis in a child.

Causes of myocarditis

There are congenital and acquired myocarditis. The causes of the development of myocarditis are very diverse and are caused by the influence of various factors.

Infections:

bacterial (for streptococcal infection, meningococcal infection, brucellosis, etc.);
viral (caused by enteroviruses, viruses, etc.);
fungal (for aspergillosis, actinomycosis, etc.);
spirochetosis (with leptospirosis, Lyme disease, borreliosis);
rickettsial (for typhus, Q fever);
caused by protozoa (malaria, leishmaniasis, toxoplasmosis, etc.).

with trichinosis;
cysticercosis;
echinococcosis, etc.

Toxic and chemical factors:

snake bite, ;
exposure to carbon monoxide, mercury, arsenic, etc.;
drug use and (in adolescents).

Physical factors:

ionizing radiation;
hypothermia;
overheating.

Effects of certain medications:

sulfa drugs;
vaccines and serums;
spironolactone, etc.

In addition to those listed, predisposing factors are also autoimmune And allergic diseases.

Of the bacterial infections, myocarditis most often develops with, and diphtheria.

Often children also experience myocarditis when exposed to toxins and congenital (developed in utero as a result of infection of a woman during pregnancy). With autoimmune myocarditis, the child’s body produces antibodies to its own heart muscle cells, which destroy the myocardium.

If we consider the cause of myocarditis depending on the age of the child, then at an early age the disease is of viral, bacterial and toxic origin, and at an older age the development of myocarditis in infectious-allergic diseases is more typical.

Autoimmune myocarditis can occur with delayed-type allergic reactions, but can also be an independent disease.

In some cases, the cause of myocarditis cannot be established, and then they speak of idiopathic myocarditis.

Symptoms

A manifestation of myocarditis may be a feeling of discomfort or pain in the heart area.

There is no clinical symptom that would allow one hundred percent accuracy to diagnose myocarditis. Myocarditis in children is characterized by severity and a rapid increase in symptoms.

Clinical manifestations of myocarditis in childhood may differ slightly depending on:

the reasons that caused myocarditis;
the depth of damage and the extent of the inflammatory process in the heart muscle;
flow option.

There are such forms of myocarditis:

according to the course: acute, subacute and chronic;
according to the prevalence of the inflammatory process: isolated (or focal) and diffuse;
by severity: mild, moderate and severe;
according to clinical manifestations: typical, erased, asymptomatic forms.

Some scientists distinguish, in addition to acute, hyperacute, or fulminant (fulminant) myocarditis, chronic active and chronic persistent variants of the course of the disease.

Inflammation of the myocardium alone is rare. Usually, in addition to the muscle, inflammation spreads to both the inner lining of the heart () and the outer lining (). In this totality, changes are found in every third child with myocarditis at an early age. The prevalence of inflammation affects the clinical manifestations of the disease.

During the newborn period (4 weeks after the birth of the baby) congenital myocarditis is severe and has the following manifestations: the baby’s skin is pale with a grayish tint; weakness is expressed (the child gets tired quickly during feeding); weight increases very slowly.

In older age In children, myocarditis occurs in acute, subacute and chronic recurrent forms, and has a more benign course. After an infection, myocarditis does not manifest itself in any way for 2-3 weeks.

Children of preschool and school age experience pain in the heart and shortness of breath. Initially, they appear only during physical activity, and subsequently - at rest. Heart pain, although not pronounced, is long-lasting and difficult to relieve with medications.

The child has sleep disturbances, increased fatigue, and fainting. Some children may experience digestive problems.

An increase in heart rate (and sometimes a decrease in heart rate due to conduction disturbances) and expansion of the boundaries of the heart are observed less frequently. But on the other hand, cardiac activity, swelling in the lower extremities, and enlarged liver may appear.

Idiopathic myocarditis differs in severity.

Diagnostics

Various methods are used to diagnose myocarditis:

Interview of the child (if age allows) and parents: the doctor finds out and details the complaints, the timing of their appearance, the presence of a previous illness, etc.
Examination of the child allows the doctor to detect pallor and cyanosis of the skin, characteristic of myocarditis; expansion of the boundaries of the heart; heart murmurs; identify increased heart rate and rhythm disturbances; the presence of edema, shortness of breath, wheezing in the lungs; determine the size of the liver and spleen; check the height and weight indicators and their correspondence to the child’s age, etc.
A clinical blood test may show an increase in the number of leukocytes, leukocyte formula indicators, acceleration of ESR, an increase in the number of eosinophils and basophils in allergic reactions.
A biochemical blood test makes it possible to determine the activity of myocardial enzymes, detect C-reactive protein, determine protein fractions, etc.
A serological blood test can detect antibodies to a previous viral infection.
Electrocardiography (ECG) in the usual way or by the method of daily monitoring (Holter method) allows you to detect disturbances in heart rhythm and conduction in the heart muscle.
makes it possible to identify the expansion of the cavities of the heart, condition, blood flow speed, etc.
X-ray of the chest organs may show expansion of the borders of the heart, stagnation of blood in the lungs.
In rare, difficult-to-diagnose cases, a biopsy of the heart muscle is performed to determine the presence and extent of the inflammatory process in the myocardium.

Treatment

Treatment of myocarditis should be comprehensive. Specific treatment for myocarditis has not been developed. The main direction is the treatment of the underlying disease that caused myocarditis.

The main components of complex therapy for myocarditis:

In the case of the bacterial nature of the infection, antibacterial drugs are used: antibiotics (most often Doxycycline, Monocycline, Penicillin, Oxacillin are used).
For myocarditis caused by a viral infection, they use (Ribavirin, Interferon, Immunoglobulins). Cardio Transfer Factor is often prescribed: an immunomodulator that has no side effects or contraindications. The drug is approved for use from the moment the child is born.

Intravenous administration of gammaglobulin increases the survival rate of children and improves the recovery of myocardial function.

Complex treatment includes: salicylates, pyrazolone drugs (Voltaren, Indomethacin, acetylsalicylic acid, Butadione, Metindol, Brufen, Hydroxychloroquine).

Hormonal drugs have a powerful anti-inflammatory and anti-allergic effect: . For severe myocarditis, Prednisolone, Hydrocortisone, Triamcinolone, Dexamethasone are used.

Hormonal therapy is indicated for severe heart failure, pericarditis, and autoimmune myocarditis. The dosage and duration of hormone use is determined individually. During treatment with hormonal drugs, medications are prescribed; it is recommended to consume foods rich in potassium (raisins, carrots, dried apricots, etc.).

When heart failure develops after stopping the inflammatory process in the myocardium, digitalis preparations are used under ECG monitoring. In case of severe heart failure, Dopamine and Dobutamine can be used.

For edematous syndrome, they use (Hypothiazide, Novurit, Fonurit, Lasix), a fasting fruit-sugar diet.

Complex treatment should include vitamin preparations, especially ascorbic acid and B vitamins. For anxiety, headaches, and sleep disturbances, symptomatic treatment is carried out.

In case of cardiac arrhythmias, antiarrhythmic drugs are selected. For particularly persistent arrhythmias, a surgical treatment method is performed: transvenous cardiac pacing or implantation of a pacemaker.

For chronic recurrent myocarditis, after a hospital course of treatment, sanatorium treatment is recommended.

Diet

If you have myocarditis, you should provide your child with proper nutrition. In mild cases of the disease, it is recommended to limit carbohydrate intake (excluding baked goods, chocolate and limiting pasta, pancakes, and baked goods). You should not feed your child rich broths, fatty meats, smoked and spicy foods, or pickles.

Even fruits such as grapes, plums, hard pears and apples should not be given to a child with myocarditis.

What can you give? A sick child will benefit from the following products:

lean beef and chicken;
liver;
fish (hake, cod, pollock, pike, pike perch);
eggs (3 pieces per week) in the form of an omelet;
any porridge;
vegetables (carrots, potatoes, cauliflower, tomatoes, cucumbers, beets, parsley and lettuce).

Fermented milk products and milk are not prohibited. You can pamper your sweet tooth with marshmallows, marmalade, honey or jam (if you don’t have allergies). Soft varieties of fresh fruit and dried fruit are also allowed.

Prognosis and outcomes of the disease

With myocarditis, the prognosis depends on the age of the child and the underlying disease that caused myocarditis.

Bacterial myocarditis often ends in recovery, but viral myocarditis, as a rule, has an unfavorable outcome.

In addition to cardiosclerosis, complications of myocarditis can include pericarditis, thromboembolism, cardiac arrhythmias, dilation of the heart cavities, and heart failure.

Chronic myocarditis in 50% of cases has a recurrent course with the development of chronic heart failure.

Myocarditis is inflammation of the heart muscle. In children, it develops mainly due to infectious diseases, allergic reactions, poisoning by toxins and congenital.

Congenital myocarditis from the first days of life is manifested by symptoms such as pale skin, weakness, and shortness of breath. Sick children get tired quickly when breastfeeding, their body weight is most often low, and their weight increases very slowly. The boundaries of the heart are expanded, tachycardia appears, and the heart sounds are muffled.

Acquired myocarditis is a consequence of past infections, including influenza and ARVI. In addition to shortness of breath and weakness, children experience nausea, vomiting, and cyanosis. Sick children sleep very restlessly, their appetite worsens, and fainting may occur.

Myocarditis is a fairly common disease in children. It occurs in most cases in boys. Infectious myocarditis occurs most often in children four to five years of age and adolescents.

The causes of the disease in children are varied: it can be a viral or fungal infection, bacteria, toxins or even protozoa. A child can also become infected in the womb.

Treatment of myocarditis in children

Prevention of myocarditis in children. Tips for parents

Intrauterine myocarditis is usually detected in the first months of life due to the onset of progressive heart failure. The child is lethargic, has an enlarged liver, muscle weakness, swelling, shortness of breath, cyanosis and tachycardia, and retardation in physical development. A medical examination for myocarditis shows an expansion of the boundaries of the heart, an increase in its size. ECG examination reflects atrioventricular block; According to the results of echocardiography, the cavities of the left ventricle and left atrium are dilated.

Myocarditis can manifest itself in three forms: acute, subacute and chronic.

Sometimes in children, myocarditis can occur with hidden cardiac symptoms or asymptomatically.

Treatment of myocarditis in children

Acute myocarditis in children is treated in a hospital setting. Patients are prescribed strict bed rest and rest. For this disease, nonsteroidal anti-inflammatory drugs (Voltaren, indomethacin) and glucocorticoid hormones are prescribed. In severe cases, oxygen therapy is used. Heart failure, conduction disorders and arrhythmia are also treated. For this, patients are prescribed drugs to improve metabolism in the myocardium and vitamins.

In infants, the prognosis of myocarditis is often unfavorable, but with adequate intensive treatment, recovery is possible. Children preschool age and schoolchildren tolerate myocarditis better; for them the disease is benign.

With chronic myocarditis, relapses are possible in 30–50% of cases, leading to the development of chronic heart failure. In such cases, therapy is complex; inpatient (6–8 weeks) and sanatorium treatment is recommended.

After recovery, the child is subject to medical supervision: he must be examined every 3–6 months for five years.

Among the complications of myocarditis are cardiosclerosis, pericarditis, myocardial hypertrophy, etc.

As mentioned above, a baby’s heart can be damaged after various infectious diseases, including flu and colds. To avoid the development of myocarditis, after recovery, parents should closely monitor the child’s condition.

First of all, you need to pay attention to how the baby tolerates physical activity, whether he rests often, and whether he develops shortness of breath after outdoor games. Lethargy, fatigue, moodiness and loss of appetite are reasons to immediately contact a pediatric cardiologist.

Even if there are no warning signs of myocarditis, try to limit your child's physical activity after the flu. The child should eat, walk and sleep at the same time. The diet includes foods that strengthen the heart muscle.

It is also necessary to measure the child's pulse at rest. Remember: the norm for infants is 150–160 beats per minute; for one-year-old children – 120 blows; for 5 year olds – 100.

The flu shot is also one of the prophylactic agents: in this way you can protect your child from infection and, accordingly, from infectious myocarditis.

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Diet for children with myocarditis

Children with myocarditis need special nutrition. In mild forms of the disease, carbohydrate intake should be limited: exclude White bread, baked goods, chocolate; limit pasta, pancakes and pancakes. You should also avoid rich broths and soups, fatty meats, smoked, spicy and salty foods.

Fruits and berries are, without a doubt, good for health, but with myocarditis, a child should not be given plums, quinces, grapes, hard apples and pears.

Bakery products should be replaced with pastries and pancakes without yeast. It is useful to give your baby lean chicken, beef and liver. Fish you can eat are pike, hake, pike perch, cod, and pollock. Eggs should be eaten carefully, no more than three per week (preferably in the form of an omelet).

Milk and fermented milk products (cottage cheese, kefir, yoghurt, sour cream) can be safely given to a sick child. Recommended vegetables include potatoes, beets, carrots, cauliflower, tomatoes and cucumbers, lettuce, and parsley. The child can eat any cereals, soft fruits and dried fruits; Sweets include honey, marmalade, marshmallows and jam.

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Causes

There are two types of myocarditis, which differ in the time of onset, namely:

In addition, the occurrence of viral myocarditis can be affected by such ailments as:

polio;
sore throat (tonsillitis);
tuberculosis;
diphtheria;
viral hepatitis;
adenoviruses;
cytomegaloviruses;
candidiasis;
Lyme disease;
typhus;
toxoplasmosis.

Infectious myocarditis is most often diagnosed in children. Often, heart problems in children begin after streptococcal tonsillitis, meningococcal infection, scarlet fever and rheumatism.

The development of cardiac inflammation can be triggered by toxic and chemical factors, for example, a wasp or snake bite, poisoning with arsenic, carbon monoxide, mercury vapor, etc.

The cause of myocarditis in children is often helminthic infestations due to trichinosis, cysticercosis, etc. Physical factors, such as hypothermia, overheating or ionizing radiation, cannot be excluded.

In addition, the disease often develops due to certain medications, especially if they were taken for a long time and intensively.

Also, in addition to the above reasons, the occurrence of myocarditis is influenced by allergic and autoimmune diseases.

The leading clinical symptom of rheumatic myocarditis in children is pain in the thoracic region, localized mostly on the left side.

The presence of symptoms depends on the cause that provoked the inflammation, the prevalence pathological process and the severity of the course.

The type of myocarditis also affects the manifestation of the disease:

fulminant inflammation;
chronic course;
acute myocarditis;
chronically active.

The inflammatory process exclusively in the myocardium is quite rare. Often this pathology is accompanied by damage to the endocardium (inner lining of the heart muscle) and pericardium (outer). The larger the area of spread of the disease, the more symptoms are observed.

With congenital myocarditis, in the first month of a baby’s life, there are the following signs of heart problems:

pale or grayish skin tone;
weakness and lethargy;
rapid fatigue during feeding;
poor weight gain;
anxiety;
swelling on the face.

Another noticeable symptom is shortness of breath and palpitations that appear in the child during bathing, bowel movements or changing clothes.

Myocarditis, which develops after an infection or against its background, is often accompanied by an increase in body temperature (up to 37.5 degrees), weight loss and refusal to eat.

In addition, the child exhibits the following symptoms:

cardiopalmus;
cyanosis of the skin;
severe abdominal pain;
passivity (refusal to play);
constant fatigue;
dyspnea;
dry cough;
fatigue.

Also, signs of heart pathologies include cold feet and hands in the baby. The physical development of a child with chronic myocarditis often does not correspond to his age. Older children may complain of joint and muscle pain that occurs both at rest and during physical activity.

If myocarditis in a child is accompanied by heart failure, then the main symptoms include:

dizziness;
headache;
pre-fainting states;
arrhythmias;
loss of consciousness;
digestive disorders;
swelling of the lower extremities.

With diffuse myocarditis, the contractile function of the heart is impaired, which can provoke congestive processes in the small and big circle blood circulation

Diagnostics

To determine the presence of myocarditis and its complications, it is necessary to conduct a thorough diagnosis, which consists of three main methods:

differential;
laboratory;
hardware room

If age allows, you should initially interview the child. It is important to find out as many of the symptoms that are bothering him as possible and when exactly they occur. It is also necessary to resort to interviewing parents to complement the clinical picture of the disease.

To determine skin changes characteristic of myocarditis, the initial examination should include a physical examination, as well as auscultation of the heart, lungs, and palpation of the liver.

The following symptoms indicate the presence of myocarditis:

pale or bluish skin;
expanded borders of the heart;
extraneous noises and wheezing;
heartbeat disturbance;
dyspnea;
liver enlargement;
swelling;
retardation in height and weight.

All these signs are significant indicators for carrying out laboratory tests and instrumental research methods. The first include taking blood to determine an increase in leukocytes, acceleration of ESR and accumulation of eosinophils and basophils if inflammation occurs due to an allergic reaction.

A biochemical blood test for myocardial inflammation indicates significant activity of myocardial enzymes, determines protein fractions and C-reactive protein. To detect antibodies to a recent viral infection, a serological test is performed.

Instrumental methods studies help to exclude other possible pathologies and assess the degree of damage to the heart muscle.

Such diagnostics consists of the following methods:

Electrocardiography	ECG is carried out both by the conventional method and by the method of daily monitoring (Holter study); such diagnostics help to determine heart rhythm disturbances and muscle conduction; changes of this kind are found in almost 95% of sick children, even in the absence of other complications.
Echocardiography	determines the exact dimensions of the heart and its cavities; depending on the neglect of the disease and the severity of its development, this method reveals disturbances in blood flow in different parts of the heart, pathological changes in the valves or expansion of the cavities.
Chest X-ray	Necessary for determining congestion in the lungs and stretching of the borders of the heart.
Heart biopsy (in some cases)	carried out in case of severity of diagnosis, in which standard methods do not allow recording the full clinical picture of inflammation; Such a study helps to more accurately understand the extent of heart damage, understand whether inflammation has penetrated the endocardium and pericardium, and also determine the type of disease and the degree of its development.

Treatment

Treatment of childhood myocarditis is carried out strictly in a hospital setting. The child is prescribed bed rest and a special salt-free diet, compliance with which is monitored by medical staff.

In case of severe illness, which is accompanied by breathing problems, the patient is given oxygen therapy.

Treatment is prescribed depending on the main causative agent of the disease, the type of myocarditis and the presence of complications. Therapy must be comprehensive. It is important to take each drug at approximately the same time.

For better recovery myocardium and increase the chance of survival, resort to intravenous administration gammaglobulin.

Complex treatment of myocarditis consists of the use of several drugs, for example, if the disease is caused by an allergic reaction, then non-steroidal anti-inflammatory drugs and antiallergic drugs are used. Most often, glucocorticoids are used for these purposes.

Severe myocarditis is treated with Prednisolone or Descamethasone. In case of severe heart failure, it is prescribed hormone therapy. It is also used when autoimmune cause inflammation of the heart wall and the presence of pericarditis.

The intensity of treatment and dosage of medications is determined purely individually for each patient. In the presence of edema, additional diuretics are given and a fasting fruit-sugar diet is used.

In addition to the above medications, therapy must include vitamins rich in ascorbic acid and potassium. Also, in case of heart pathologies, it is necessary to periodically consume B vitamins.

If there is dizziness, fainting, weakness, lack of appetite and other symptoms, additional medications are prescribed to relieve symptoms that worsen the child’s condition. Heart rhythm disturbances are eliminated with special antiarrhythmic drugs.

In the case of chronic recurrent myocarditis, after hospital treatment, therapy should be continued at home, strictly adhering to medical instructions.

Forecasts

The success of treatment and survival depends on the timely diagnosis of the disease and the underlying cause that provoked the development of inflammation of the heart muscle. Also, the age of the young patient and the presence of concomitant diseases are of no small importance in prognosis.

A high percentage of deaths is observed among newborns and children under three years of age. If such patients survive, sclerotic changes and heart failure of chronic etiology develop in the myocardium. All these pathological changes in the organ end early death child.

Most often, bacterial myocarditis has a favorable prognosis; it almost always ends in the baby’s recovery. The same cannot be said about viral inflammation of the myocardium.

In children of preschool and school age, treatment of myocarditis ends successfully. The development of heart failure and the formation of sclerotic scar lesions depends on the duration of absence of treatment. The sooner you start therapy, the greater the chance that the disease will not leave complications.

The prognosis of myocarditis worsens in the presence of such consequences as cardiosclerosis, thromboembolism, pericarditis and arrhythmias. In half of all cases, myocardial inflammation has a recurrent course with subsequent development chronic failure hearts.

Diet

Myocarditis is a good reason to provide the child with proper nutrition.

In case of mild inflammation of the heart muscle, the following should be excluded from the diet:

chocolate;
fresh baked goods;
limit pasta consumption;
reduce the amount of salt you eat;
monitor your drinking regime.

It is necessary to reduce or completely eliminate fatty, fried and smoked foods. Also, you should not overuse sweets, rich broths and pickles.

A child with chronic myocarditis should be given hard fruits such as plums, grapes, pears and apples in small quantities and infrequently. Or better yet, give them up altogether.

For myocarditis, the following foods should be present in the child’s diet:

liver (not fried);
lean meat;
low-fat fish (pollock, hake, pike perch, etc.);
eggs (omelet or boiled);
cereal porridge;
fresh vegetables;
boiled carrots and beets;
greens (parsley, dill, lettuce, etc.).

As a drink, it is allowed to give compote of berries or dried fruits, fresh juices, kefir, and yoghurts. It is necessary to completely stop consuming carbonated drinks, cocoa and coffee drinks.

For sweets, you can give marmalade, marshmallows, homemade jam or honey, the main thing is not to overuse these delicacies.

Prevention

To avoid congenital myocarditis to the expectant mother Pregnancy should be planned carefully. It is best to get tested for hidden infections and treat all chronic diseases before conception.

During pregnancy, you should avoid crowded places during the period of colds and flu, and if infection cannot be avoided, treatment should be carried out under the supervision of a doctor.

To prevent acquired myocarditis in the autumn and winter, it is necessary, if possible, to exclude the baby’s contact with sick people. In order to prevent myocardial inflammation due to “childhood” infections, it is necessary to carry out routine vaccination in a timely manner.

Before the onset of seasonal colds, it is important to strengthen the child’s immunity with the help of a vitamin complex and healthy foods. When a cold begins, be sure to visit a pediatrician, and after recovery, undergo the necessary tests to rule out any complications after the illness.

You also need to monitor the child’s daily routine, visit the dentist in a timely manner and not leave diseases such as tonsillitis, sinusitis, gingivitis, etc. untreated.

No matter how hard mothers and fathers try, it is simply impossible to completely protect a child from infectious and viral diseases. But it is quite possible to prevent their complications, and only attentive parents can do this.

To stop the development of myocarditis at the earliest stage of its occurrence, the child should be taken to the doctor at the first changes in behavior and health that appear. These include: fatigue, lethargy, drowsiness, unusual moodiness for the baby, loss of appetite and shortness of breath.

You need to monitor your child especially carefully after suffering an infectious disease, and if there is the slightest suspicion of complications, you must visit the clinic for tests.

If your child has any health complaints, you should take him to a pediatrician or family doctor. Only after an initial examination can they suspect the presence of a complication and refer it to the right specialist.

In case of myocarditis, the child needs to be diagnosed by a cardiologist. Depending on the cause of myocardial inflammation, examination by an allergist, rheumatologist, infectious disease specialist or immunologist may be necessary.

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Symptoms

Myocarditis in childhood can sometimes be difficult to diagnose because it may not cause symptoms. The congenital disease is detected quite quickly due to the occurrence of developing heart failure. At the same time, the baby is lethargic, he experiences swelling, muscle weakness, shortness of breath and insufficient physical development.

Medical examinations detect changes in the size of the heart, usually increasing. The first symptoms appear in more than half of sick children during the development of a viral infection or a week later. The main features include:

pain in the chest;
cardiopalmus;
fatigue for no apparent reason;
shortness of breath;
in some cases, increased temperature;
cold feet and hands;
weak and rapid pulse.

Symptoms of the disease in children and adults may be different.

Note! Inflammation in the heart can occur due to a reaction to antibiotics or a vaccine.

It is necessary to understand that myocarditis in children can have a chronic, progressive and acute course.

Causes of the disease

The disease appears as a result of acute viral and bacterial infections. It is during various epidemics that the number of sick adults and children increases. Symptoms of the disease may appear in the presence of one or two different infections. In addition, the disease may appear due to decreased immunity.

Important! With this disease, physical activity is contraindicated.

The following common reasons can be identified:

Types of myocarditis

Studying the symptoms, we can distinguish the following forms of this disease:

Infectious and toxic.
Immune or allergic.
Toxic-allergic.
Unexplained nature.

According to the course, myocarditis is classified into acute, chronic and subacute. Symptoms different types differ considerably.

Diagnostics

This disease has no specific signs, so the diagnosis is made using laboratory methods And clinical symptoms. For correct diagnosis, the following methods are used:

When carrying out diagnostics, daily ECG indicators are used. This method helps to calculate the size of the cavities of the heart. For determining viral etiology blood is checked, antibodies to viruses are examined. Treatment is prescribed only after an accurate diagnosis has been made.

Treatment

For acute myocarditis, children are treated in inpatient conditions. Patients are prescribed constant rest and bed rest. Anti-inflammatory drugs, such as Voltaren and indomethacin, are prescribed as drug treatment. IN difficult cases oxygen therapy is prescribed.

Patients are also prescribed drugs to increase metabolism and various vitamins. For infants, such a disease is dangerous, but using effective treatment full recovery is possible.

School-age children tolerate myocarditis more easily. At chronic illness relapses often occur, leading to heart failure. In this case, treatment has an integrated approach and consists of inpatient and sanatorium rehabilitation. After recovery, the child needs to undergo regular follow-up for several years.

This disease may have complications: myocardial hypertrophy or pericarditis. In the acute phase, sick children should adhere to bed rest for 2 weeks to reduce the body's need for blood circulation. Acute myocarditis is treated with intravenous gammaglobulin.

To improve the health of children, symptomatic therapy is often used, especially for heart failure. In cases of severe deficiency, dopamine and dobutamine are used.

Important! Children who have had myocarditis should be periodically examined by a doctor.

For this disease, a special salt-free diet is recommended to help reduce stress on the heart. Infectious myocarditis is treated with antibiotics. Diuretic medications are also used to reduce the workload on the heart.

Drug therapy depends on the type of disease and the causes of its occurrence. Additionally, procedures are performed to increase myocardial metabolism and treat heart failure and arrhythmia.

Prediction depends on the patient’s age, the state of his immunity and the causes of the disease. Most patients who have light form illness, recover completely and have no heart complications. After an illness, the child should regularly visit the pediatrician and periodically have an ECG.

Types of therapeutic therapy

Depending on the type of myocarditis, doctors prescribe certain treatment:

For bacterial myocarditis, antibiotics are used: doxycycline or vancomycin. Antiarrhythmic drugs are used for arrhythmia, and strophanthin and corglycone are used to stabilize the heart. To improve metabolism, mildronate, panangin or riboxin are used. Anticoagulants are effective against thromboembolic complications.
Drug treatment viral disease involves taking cardiac glycosides, diuretics and ACE inhibitors.
For rheumatic myocarditis, non-steroidal anti-inflammatory drugs, as well as glucocorticosteroids, are prescribed.
When treating an allergic type of disease, the allergen should be immediately eliminated. Antihistamines are also used.
Toxic myocarditis is treated by relieving the main symptoms of the disease. Symptomatic therapy is also used for burn types of the disease.

Prevention

To prevent the disease, you need to use preventive measures. It is necessary to carry out intensive treatment of the infection that has arisen in the body: chronic tonsillitis, inflammation oral cavity or sinusitis.

The child should not come into contact with people suffering from various infectious diseases. Effective protection is vaccination against infectious diseases such as rubella, polio and seasonal influenza vaccination.

After suffering from infectious diseases, parents should monitor the condition of their child. You should pay attention to how the baby copes with physical activity whether shortness of breath appears after active games and whether it is often interrupted for rest.

TO alarming symptoms include increased moodiness and loss of appetite. In any case, after the flu it is worth reducing the child’s activity. The diet should include foods that help strengthen the heart muscle.

It is important to monitor the child's pulse when he is at rest. For five-year-old children, the norm can be considered 100 beats per minute, for one-year-olds - 120, and for infants 150-160.

For prevention, you need to treat diseases in time and strengthen all body systems and the heart muscle. The following main preventive measures can be identified:

Increasing the overall standard of living.
Maintaining healthy image life.
Healthy and nutritious nutrition, hardening and use of vitamin complexes.
Isolation of patients from schools and kindergartens was carried out in a timely manner.
Complete treatment of any emerging diseases.
Taking antibiotics as prescribed by a doctor and following the instructions correctly.

Myocarditis is a common disease among children. It can be very dangerous if measures are not taken in time, which is why it is so important to monitor the health of your children. From an early age, children need to be taught to lead a healthy lifestyle, which includes proper nutrition, exercise, and physical activity.

You should also take care during the cold season at the peak of various epidemics and not visit public places unless necessary. Performance simple rules will help the child stay healthy and avoid myocarditis.

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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 diagnosed in patients of different ages. Myocarditis in a child or adolescent can hardly be regarded as a rare case.

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

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 has a bacterial origin. The disease develops against the background of tuberculosis, brucellosis, and bacterial meningitis. The inflammatory process appears when streptococcal infection is activated.
Damage to the body by rickettsia often leads to inflammation of the heart muscle. Risk factors include Q fever, typhus, and Rocky Mountain fever.
Pathogenic fungi, in particular fungi of the genus Candida, can act as a pathogen.
There are also protozoal myocarditis that develop against the background of toxoplasmosis, malaria, and 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 medicines, after vaccination or administration of serums.

Risk factors include snake and insect bites.
Physical effects, for example, severe hypothermia, overheating, effects on the body ionizing radiation 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 discussed above. But during diagnosis, experts pay attention to other factors:

When it comes to the course of the disease, myocarditis can be acute, chronic or subacute.
Depending on the severity, the disease can be mild, moderate or severe.
The doctor also pays attention to the clinical manifestations - in children you can notice a typical form of inflammation, as well as erased and asymptomatic ones.
The degree of spread of the inflammatory process also matters - in in this case There are focal (there is an isolated, single area of inflammation) and diffuse myocarditis (the pathology spreads to the entire muscle).

How does myocarditis develop in children? Main stages

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

Viremia stage - viral particles (or other pathogens) enter the myocardium. First, they are fixed on the surface of muscle cells, and then penetrate into the myocytes. At this stage, activation of the immune system is observed, which is accompanied by increased synthesis and release of interferon.
An autoimmune stage, in which the immune cellular response is significantly enhanced and the level of anticardiac antibodies increases, which accumulate in the myocardium, negatively affecting its function. At the same stage, inflammatory mediators are activated. Microvascular damage is observed.
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 therapy did not give positive results(or was completely absent), the disease becomes chronic. At chronic inflammation Complications gradually develop, including heart failure, cardiomegaly, and cardiosclerosis.

The diagnostic process and examination of the child help the doctor find out the form of the disease, its causes, as well as the stage of development - only after receiving this data can a truly effective scheme treatment.

Symptoms of the disease in a newborn

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

Another symptom is shortness of breath. It first appears during periods of activity - the baby breathes quickly and heavily while changing clothes, bathing, defecating, and feeding. As the disease progresses, breathing difficulties can be observed even in a calm state. Due to developing heart failure, edema appears - sometimes it is very pronounced, due to which the baby’s weight increases sharply. Examination of the child reveals an enlarged liver and spleen.

Features of the clinical picture in a child over two years old

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

pale skin;
fatigue, weakness, slight increase in temperature;
loss of appetite and, accordingly, loss of body weight;
soreness in muscles and joints, and sometimes in the abdomen;
as the disease develops, children begin to complain of pain in the heart area;
shortness of breath and rapid heartbeat appear.

Myocarditis: diagnosis of the disease

With such a disease, correct diagnosis is of great importance. It is best to contact the children's cardiology center with your child. To make a diagnosis, the following procedures are necessary:

To begin with, a survey of the child and parents is conducted to take an anamnesis and determine the presence of certain symptoms.
Already during the examination, the doctor may suspect myocarditis - the 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 makes it possible to determine the presence of infection and inflammatory process.
X-ray of the chest organs allows the specialist to see the expansion of the boundaries 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 required - such procedures make it possible to examine the functioning of the heart and assess the degree of disturbances.
Myocardial biopsy is indicated only in the most severe cases, as it helps determine the extent 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, if there is bacterial infection Antibiotics are needed, and for viral infections, antiviral medications are indicated. Children are also prescribed immunomodulators to normalize the functioning of defense mechanisms.

To eliminate the inflammatory process, patients take anti-inflammatory non-steroidal drugs (Voltaren, Brufen, Indomethacin). In especially severe cases, steroid hormonal medications are used, which are more effective in combating inflammation. To eliminate edema, diuretics are used to get rid of excess fluid. It is also important to include vitamin preparations in the treatment regimen. If we are talking about chronic process, then sanatorium treatment is indicated. If there is a persistent arrhythmia that cannot be controlled drug treatment, you may need to have a pacemaker implanted.

Treatment is carried out in a hospital setting, it is advisable to choose a good children's cardiology center with good specialists. At the end of the course of therapy, the child must still undergo regular examinations - first every few months, and then twice a year (if the course of the disease is favorable). 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.

Diet of a child with myocarditis

Many parents today are interested in questions about why myocarditis develops and what it 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 we are not talking about a baby).

Experts recommend giving up simple carbohydrates—do not give your child baked goods, chocolate, white bread, or pasta. You can replace them with baked goods without yeast. Also, do not overuse salty and spicy foods, fatty meats and fish, rich soups and broths - it is better to eat lean chicken fillet and liver (by the way, it is advisable to steam dishes). Fish is allowed, but only if we are talking about low-fat varieties. The number of eggs should also be limited.

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

Prognosis for myocarditis

Myocarditis in a child is especially dangerous in the first months of life - it is in this age group The most common outcome in patients is death. Prognosis depends on the form and severity of the disease. For example, light form Sometimes the disease 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 very good.

Adverse cases are rarely recorded among school-age children and adolescents - as a rule, children recover fairly 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.

Preventive agents

Unfortunately, there is no universal cure for myocarditis. Nevertheless, experts recommend following some rules. A pregnant woman should be attentive to her health, prevent the development of infectious diseases, avoid contact with toxins, and get tested regularly.

The condition of the newborn should be carefully monitored - infectious and inflammatory diseases should be diagnosed and treated in a timely manner. During outbreaks of colds, if possible, you should not allow your child to come into contact with infected people. Proper nutrition, a clear daily routine, moderate physical activity and hardening.

Good day, dear parents. In this article we will talk about what myocarditis is in children. You will become aware of the characteristic signs of this condition and the main causes of its occurrence. You will learn how to diagnose the disease and how to treat it. You will know what needs to be done to prevent your baby from such a pathology.

Definition and classification

Inflammation that occurs in the myocardium (heart muscle) is called myocarditis.

Because of the way the disease occurs, there are three forms:

chronic;
subacute;
spicy.

Based on the severity they distinguish:

medium-heavy;
heavy;
easy.

Based on the presence of characteristic manifestations, the following are distinguished:

erased form;
typical myocarditis;
asymptomatic disease.

Also pay attention to the spread of inflammation:

focal, when there is a clearly limited area of inflammation;
diffuse - inflammation affects the entire muscle.

There are two main stages of development of this disease.

Viremia. Pathogens penetrate the myocardium, fixate on muscle cells, and invade myocytes. The immune system is activated, resulting in an increase in the level of interferon secretion.
Autoimmune. The immune cellular response becomes more intense, and anticardiac antibodies increase. They accumulate in the myocardium, thereby harming its functioning. Inflammatory mediators appear and microvascular injury occurs. If the disease begins to be treated, the swelling decreases and fibrous areas appear. If there are no favorable results, the disease develops into a chronic one. At the same time, complications develop over time, in particular cardiosclerosis, cardiomegaly and heart failure.

This pathology in children has its own characteristics.

The lack of specificity of signs of the disease often leads to a delayed diagnosis and the onset of heart failure.
Autoimmune diseases, which can affect not only the heart, affect inflammation either only of the myocardium, or of all the cardiac membranes.
Myocarditis suffered in childhood can influence the development of cardiomyopathy. This disease is irreversible. The only chance for recovery will be an organ transplant.
Does not exist specific treatment. The therapy is comprehensive, aimed at maintaining the baby’s immunity at the required level.

Possible reasons

Viruses are common causative agents of myocarditis

The disease can begin to develop both during the prenatal period and after the birth of the child. The main factors that influence the development of pathology are infection of the body by pathogenic microorganisms.

Viruses. They are the most common cause of the development of this pathology. The main pathogens are:

enteroviruses;
some viruses;
herpes;

HIV is transmitted from a pregnant woman to her fetus through the placenta. It affects the decrease in immunity, making the baby’s body susceptible to any pathogens.
Lyme disease, which develops after contact with a tick or its bite. Occurs due to infection with bacteria of the genus B. When it enters the myocardium, it provokes inflammation. In this case, there is damage to the joints and skin of the baby.
Protozoa, namely mycoplasma, chlamydia. In most cases, infection occurs when passing through the birth canal during childbirth. In adolescent children, it may indicate an early onset of sexual activity.
Fungal infection. Affects inflammation of the heart muscle with a concomitant infectious process in the body.

Characteristic manifestations

Heart pain is one of the signs of myocarditis

Parents should know that the main symptoms indicating the presence of myocarditis are very similar to diseases of the lungs and heart, which can make diagnosis difficult. The main features include:

presence of shortness of breath even at rest;
pain of any intensity in the heart;
arrhythmic pulse;
swelling of the limbs;
manifestation of the infectious process, namely fever, weakness, sweating;
interruptions in cardiac function;

Diagnostics

First of all, the child is interviewed, complaints are collected, and the time of appearance of the first signs of health problems is determined. The doctor will find out what diseases preceded this condition.
A thorough examination of the patient allows you to detect cyanosis and pallor of the skin, listen to the heartbeat, and pay attention to the presence of signs characteristic of myocarditis.
To clarify the expected diagnosis, the specialist will refer the child for additional examination:

general blood analysis;
serological analysis - will reveal the presence of antibodies from an early infection;
biochemical blood test;
Echocardiography - allows you to identify the expansion of the heart cavities and determine the condition of the valves;
breasts
sometimes a heart biopsy may be prescribed, which will determine how intense the inflammation is in the myocardium.

Possible complications

Arrhythmia is a possible complication of myocarditis

In the absence of proper treatment or the presence of an advanced condition, serious consequences for the child’s body can develop:

dilated cardiomyopathy;
cardiosclerosis;
arrhythmia;
thromboembolism;
heart failure.

Parents should understand that if there is no treatment, death cannot be ruled out. This indicator is especially high in newborns.

Basis of therapy

Treatment of acute myocarditis occurs in a hospital setting. The baby will be put on bed rest. If there is a severe case - oxygen therapy. The therapy will be complex. Its basis is actions aimed at the disease that provoked the development of myocarditis.

If you have previously had a bacterial infection, then antibiotics are prescribed, in particular Penicillin and Monocycline.
If the disease was viral, antiviral drugs are prescribed, in particular Interferon or Ribavirin.
Immunomodulators, for example, Transfer Factor Cardio, may be prescribed.
In order to improve myocardial function, gamma globulin is administered intravenously.
Nonsteroidal anti-inflammatory drugs, for example, Butadione or Voltaren, may be prescribed.
If there is prolonged pain syndrome- V minimum dose Anaprilin is prescribed.
Hormonal agents have antiallergic and strong anti-inflammatory effects.
If myocarditis is in a fairly advanced form, Prednisolone or Dexamethasone is prescribed.
For autoimmune myocarditis, hormonal therapy with the use of potassium-containing products will be prescribed.
If heart failure occurs, Dopamine is prescribed.
If swelling is present, use a diuretic, in particular Fonurit, as well as a sugar-free diet.
Vitamin therapy is mandatory, especially taking representatives of group B and vitamin C.
If there are signs of arrhythmia, appropriate medications are prescribed.
It is important to exclude the possibility of hypothermia and transfer the child to a special physical education group, therefore, reduce physical activity.
If myocarditis has become chronic, then after hospitalization a visit to a sanatorium is recommended.

A child diagnosed with myocarditis must be registered with a cardiologist for at least five years after hospital treatment. You must visit a specialist every month for a four-month period. Then once a trimester for a year, then twice a year.

Diet features

The child should be given exclusively steamed meals.
Meals should be fractional, six times a day, in small portions.
Permitted ones include:

lean meat, in particular chicken or veal;
low-fat fish;
porridge;
fruits, with the exception of grapes, hard apples and pears, quinces and plums;
stewed and boiled vegetables;
dairy products;
egg omelet (no more than three eggs per week);
dried fruits.

If you want to please your baby with sweets, the following are acceptable:

honey (if there is no allergy);
jam;
marshmallows;
marmalade

Products that need to be limited include:

fresh bakery;
baking;
chocolate.

You need to completely exclude:

fried foods;
fat;
spicy;
rich broths;
soda.

If a child has edema, then it is necessary to limit salt intake (the maximum allowable norm is 6 grams per day).
If a child has been prescribed diuretics and given corticosteroids, then his diet needs to be supplemented with potassium-containing foods, in particular carrots, dried apricots, and raisins.

Prevention

Timely examination of a woman before pregnancy and compliance with precautions during pregnancy are of great importance.
Prevent your baby from coming into contact with sick people.
Get vaccinated on time and follow the vaccination schedule. During a flu epidemic, also get the appropriate vaccination.
If chronic diseases occur, in particular, or, stop them in a timely manner.
If you have any complaints about your health, consult a doctor in a timely manner and follow all his recommendations.
If there is an infectious process in the baby’s body, limit his physical activity.
Establish a daily routine and strictly follow it.

Now you know what myocarditis is, what clinical recommendations for recovery exist. As you can see, sometimes difficulties arise in making a diagnosis; it is especially difficult to identify this disease in young children who are not yet able to speak and complain about bad feeling. Remember about possible complications myocarditis. At the first suspicion of heart problems, consult a doctor, do not delay.

Myocarditis in a child is relatively often diagnosed in modern medical practice. It should be said right away that this disease is dangerous and, if left untreated, can lead to severe complications. That is why many parents are interested in information about this disease. Why does such a disease develop even in infants and what symptoms should you pay attention to? What does therapy look like and what are the prognoses for young 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 damage to the myocardium can be very different, ranging from the penetration of infection into tissues and ending with severe allergic reactions and intoxications. Quite often, inflammation affects not only the heart muscle, but also neighboring structures, including the pericardium, blood vessels and other organs.

Main causes of myocarditis

Believed to be associated with virtually 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 has a bacterial origin. The disease develops against the background of tuberculosis, brucellosis, and bacterial meningitis. The inflammatory process appears when streptococcal infection is activated.
Damage to the body by rickettsia often leads to inflammation of the heart muscle. Risk factors include Q fever, typhus, and Rocky Mountain fever.
Pathogenic fungi, in particular fungi of the genus Candida, can act as a pathogen.
There are also protozoal myocarditis that develop against the background of toxoplasmosis, malaria, and 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 administration of serums.

Risk factors include snake and insect bites.
Physical impact, for example, severe hypothermia, overheating, exposure to ionizing radiation on the body also provokes the 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

When it comes to the course of the disease, myocarditis can be acute, chronic or subacute.
Depending on the severity, the disease can be mild, moderate or severe.
The doctor also pays attention to the clinical manifestations - in children you can notice a typical form of inflammation, as well as erased and asymptomatic ones.
The degree of spread of the inflammatory process is also important - in this case, focal (there is an isolated, single area of inflammation) and diffuse myocarditis (the pathology spreads to the entire muscle).

How does myocarditis develop in children? Main stages

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

Viremia stage - viral particles (or other pathogens) enter the myocardium. First, they are fixed on the surface of muscle cells, and then penetrate into the myocytes. At this stage, activation of the immune system is observed, which is accompanied by increased synthesis and release of interferon.
An autoimmune stage, in which the immune cellular response is significantly enhanced and the level of anticardiac antibodies increases, which accumulate in the myocardium, negatively affecting its function. At the same stage, microvascular damage is activated.
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 therapy does not produce positive results (or is completely absent), the disease becomes chronic. With chronic inflammation, complications gradually develop, including heart failure, cardiomegaly, and cardiosclerosis.

Symptoms of the disease in a newborn

Features of the clinical picture in a child over two years old

covers;
fatigue, weakness, slight increase in temperature;
loss of appetite and, accordingly, loss of body weight;
soreness in muscles and joints, and sometimes in the abdomen;
as the disease develops, children begin to complain of pain in the heart area;
shortness of breath and rapid heartbeat appear.

Myocarditis: diagnosis of the disease

With such a disease, correct diagnosis is of great importance. It is best to go to the children's office with your child. To make a diagnosis, the following procedures are necessary:

To begin with, a survey of the child and parents is conducted to take an anamnesis and determine the presence of certain symptoms.
Already during the examination, the doctor may suspect myocarditis - the 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 makes it possible to determine the presence of infection and inflammatory process.
X-ray of the chest organs allows the specialist to see the expansion of the boundaries 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 required - such procedures make it possible to examine the functioning of the heart and assess the degree of disturbances.
Myocardial biopsy is indicated only in the most severe cases, as it helps determine the extent 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 in case of viral infections, antiviral drugs are indicated. Children are also prescribed immunomodulators to normalize the functioning of defense mechanisms.

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

Diet of a child with myocarditis

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 death is most often observed. Prognosis depends 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 very good.