Symptomatology diagnosis and treatment of rheumatoid myocarditis

The treatment of myocarditis, as well as its diagnosis, should be comprehensive. Key tasks are to eliminate the pathogen that provoked the disease, relieve inflammation and eliminate symptoms.

It is important to know: if myocarditis is in acute form, you need hospitalization in a hospital, and it does not matter if myocarditis first occurs or is this another exacerbation, as happens, for example, with rheumatic myocarditis.

It’s simple: without a professional diagnosis, it is impossible to make an accurate diagnosis and understand what is the cause of myocarditis in your case.

It can take years to treat with pills for a disease that you don’t have, while a disease that causes myocarditis and myocarditis itself will progress further. And the risk of developing dangerous complications, fraught with death, over the years will increase in the literal sense of the word every day.

Remember: timely diagnosis of myocarditis is one of the most important conditions for successful treatment. Do not delay a visit to a cardiologist if you have even the slightest discomfort in the area of ​​the heart.

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First, the doctor makes an initial examination of the patient, draws attention to the symptoms of rheumatic myocarditis (if any). This is a shade of the skin of the fingertips, as well as the tip of the nose (their cyanosis may indicate heart pathologies). In addition to shortness of breath, swollen legs and swollen veins on the neck, he notes the patient’s posture, which allows him to improve breathing. This pose is resting on the arms.

But the external signs of a pathological condition are not enough to make an accurate diagnosis. Therefore, resorting to instrumental research:

  • an electrocardiogram shows abnormalities in the rhythms of the contraction of the heart;
  • X-ray, CT, MRI give a visualized picture that shows the size of the heart, the thickness of its walls, etc .;
  • Ventriculography allows you to take pictures of the heart chambers and assess their condition;
  • ultrasound diagnostics of the heart provides information about myocardial enlargement.

Based on instrumental studies, the doctor gives a description of the micropreparation for rheumatic myocarditis, where it notes the places affected by the development of the inflammatory process.

In addition to these studies, laboratory tests are also carried out, which gives a complete picture of the state of this organ.

In severe cases, the patient is hospitalized. The treatment plan includes the use of antiviral, antibacterial agents aimed at eliminating the infection that affects the human body. With exacerbation, the patient is shown bed rest.

At the next stage, the patient is treated with anti-inflammatory and symptomatic agents.

Preventive measures include the prevention (or timely treatment) of rheumatism. A full-fledged diet, a healthy lifestyle and a positive attitude will help to achieve this.

Secondary prevention of such patients includes the introduction of bicillin-5.

The prognosis for such a pathology depends on the severity of the disease, as well as the effectiveness and timeliness of treatment.

Causes of the disease

Myocarditis is a disease associated with acute rheumatic fever (ARF), which is preceded by tonsillitis, pharyngitis, scarlet fever, otitis media, and other diseases in which the causative agent is group A β-hemolytic streptococcus (BHS-A).

Thus, streptococcal infection is the cause of rheumatic myocarditis, which triggers the processes:

  • direct damage to myocardiocytes by virulence factors of BHS-A;
  • autoimmune destruction of the myocardium;
  • microcirculatory disorders, the formation of micronecrosis and myocardiosclerosis.

According to the World Health Organization, among 20-50% of schoolchildren with acute pathology of the upper respiratory tract, there is an invasion of BGS-A. At the same time, no more than 3-4% of them get rheumatism.

1. Unusual properties of a pathogenic agent. β – hemolytic group A streptococcus has specific antigenic properties similar to those in the structures of the heart, brain, synovial and serous membranes and other tissues. This predetermined the “many faces” of rheumatism.

2. A peculiar immune response of the body to the invasion of streptococcus. Disoriented anti-streptococcal antibodies with no less zeal attack tissues antigenically identical to bacterial aggressors, including myocardium, taking them for BHS-A antigens.

3. Human exposure to the disease. Having a family history (genetic predisposition) increases the chances of getting rheumatism three times.

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4. An important trigger factor is the sensitization of the body. Only a repeated attack of streptococci can lead to ARD, which explains the resistance to it of children under the age of 3-5.

Complications after previously transferred infectious diseases caused by group A streptococcus. A common cause of the formation of pathology. Doctors identified other factors that provoke rheumatic acute or chronic carditis:

  • hereditary predisposition;
  • prolonged exposure to unsanitary conditions;
  • congenital abnormalities in the work of the heart;
  • congenital abnormalities of the heart muscle.

At-risk patients undergo an annual examination. The doctor makes recommendations aimed at minimizing the likelihood of developing the disease.

The severity of symptoms is a factor on the basis of which the doctor determines the type of pathology. The second parameter is the duration of the pathogen’s presence in the body and the time the first symptoms are fixed. In medicine, 4 varieties are recorded:

  1. Primary (initial) – occurs almost immediately after a previous infectious disease. At risk are people who often complain about problems with the respiratory system. In the initial form, the pathogen affects the mitral valve. Lack of timely medical care leads to damage to the joints and kidneys.
  2. Return – in many ways similar to the type described above. The only difference is that recurrent rheumatic heart disease develops against the background of existing heart muscle defects. The patient is diagnosed with rheumatism of the joints.
  3. Acute – the disease begins and develops rapidly. The patient has rheumatic fever. The clinical picture is supplemented by a violation of the central nervous system. Less often, the patient complains of itching.
  4. Chronic – the development of the disease is stretched over time. The process takes up to 7-8 months. The patient has no pronounced clinical manifestations. Mentioned fact makes early diagnosis difficult

Prompt and professional medical help will allow you to submit symptoms of acute rheumatic heart disease in a short time. Three other types of rheumatic heart disease are difficult to treat.

Depend on the diagnosed stage of the disease. Weak (I) has no specific symptoms. Pathological changes can be detected only during the examination. The second stage is moderate (II). Surgical medical intervention minimizes the risk of the appearance of the third stage – severe (III).

The second classification is based on the volume of the affected tissue. The diffuse form is practically not found. The reason is the high accuracy of the diagnostic equipment. It has become easier for doctors to detect the disease. The second form is focal. The localization of the inflammatory process has clear boundaries. Depending on the activity of the pathogen, the focal form is of four types:

The speed of the disease depends on the effectiveness of the immune system. During the initial appointment, the doctor relies on the patient’s complaints. They are the basis for the appointment of further examination.

PrimaryAppears suddenly. The patient complains of high fever, joint pain, an increase in the number of white blood cells in the blood. An advanced blood test will enable diagnosis.At the initial stage, signs of rheumatic heart disease are practically absent
Rheumatic pericarditisIt happens dry or with the appearance of fluid in the heart bag. The patient complains of shortness of breath, swelling of the lower extremities, a sharp drop in blood pressureThe pain is practically absent. Unpleasant sensations occur only in the presence of severe complications
Rheumatic myocarditisMost patients are diagnosed with a sluggish current focal form. The patient does not complain. Pathology can be detected by ECG results. The patient has a change in heart rateWith timely initiation of treatment, the risk of complications is minimal
Diffuse myocarditisThe patient complains of chest pain, difficulties with independent movement, hemoptysis and frequent fainting. Patients constantly occupy a forced position on the bed to reduce discomfortDiffuse rheumatic heart disease and its symptoms are the basis for immediate hospitalization. Pathology has a high risk of mortality.
Rheumatic endocarditisThe patient has severe heart failureThe tissue of the heart muscle gradually atrophies. It is replaced by scar fibers.
Age-related myocarditisThe patient fixes repeated attacks. Marked damage to the layers of the heart muscles is observed.Pathology does not have specific symptoms. You can make a diagnosis based on the results of a comprehensive examination. The forecast is almost always unfavorable
Children’s rheumatic heart diseaseThe disease is almost always a complication of infectious lesions of tissues and organs. At the initial stage, there are no symptoms. With the further development of heart muscle lesions, the patient complains of heart painIt is diagnosed in children aged 7-15 years. Due to the insufficient development of the heart muscle, rheumatic heart disease develops rapidly

Patients are often confused by the underlying and concomitant symptoms of rheumatic heart disease, believing that they have an influenza. Doctors call for sanity. Only on the basis of the results of a comprehensive examination can a diagnosis be made. The sooner everything is done, the more likely it is to recover.

Takes up to 5 days. The danger is that rheumatic heart disease rarely manifests itself at an early stage. The patient feels well until the pathology passes into an acute form. The first and most effective test is a general blood test. The doctor pays attention to three parameters:

  • rheumatoid factor;
  • sedimentation rate of erythrocytes;
  • specific protein concentration level.
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A third way to detect the disease is to consult another doctor. It is necessary in case of insufficient severity of clinical manifestations.

Anti-inflammatory drugs based on aspirin or its analogues are used by a doctor at any stage of the disease. Even after discharge, the patient is recommended to take the prescribed drug. The second class of drugs is antibiotics. The composition and duration of the course is selected by the doctor. You can not change the dose yourself.

Patients diagnosed with a chronic form of rheumatic heart disease take Plaquenil or its analogues. Complete the list of vitamins. Rheumatic heart disease in any form of treatment requires strengthening the body. As in the previous case, the doctor selects vitamins taking into account the degree of prevalence of the pathology.

Drug treatment is carried out under permanent medical supervision. It happens that after 5-8 days the body does not respond to drugs, the prescribed course is changed.

Surgical intervention is necessary if the patient has a pronounced heart disease. The second reason for appointing an operation is the presence of a life threat.

Exercise therapy will help increase the effectiveness of the course of treatment. The course of exercises will be selected by the doctor. Independence is unacceptable. Excessive stress will accelerate the course of the disease. The second component of success is a change in diet. The manifestation of rheumatic heart disease will become less disturbing if the patient excludes harmful products from the diet:

The emphasis is on products with a high content of useful things necessary for the heart. The top list includes fish, milk and its derivatives. An important role in restoring the full functioning of the body is played by the consolidation of the achieved result.

People who have had rheumatic heart disease and those who are healthy constantly monitor their health. The first rule is annual preventive examinations. The second rule – as soon as an acute respiratory viral infection or other disease has made itself felt, they immediately go to the doctor.

In 9 cases out of 10, rheumatic heart disease is the result of complications of infectious lesions of the body.

Rheumatic heart disease is an inflammatory process in the connective cavities of the heart. Only a doctor can notice the primary symptoms and prescribe treatment. Unfortunately, individual forms of rheumatic heart disease are difficult to diagnose.

The patient does not feel anything, which complicates the work of the doctor. Pathology can be suspected on the basis of a detailed blood test. It is recommended to take it 2 times a year.

Early diagnosis of rheumatic heart disease allows the doctor to make a positive prognosis.

To date, rheumatic heart disease is a rare disease. This is a manifestation of rheumatic fever, accompanied by damage to all layers of the heart and largely determines the severity and outcome of rheumatism. The disease mainly affects children 5 to 15 years old. It is caused by streptococci, therefore antibiotics are used for treatment.

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Svetlana Borszavich

General practitioner, cardiologist, with active work in therapy, gastroenterology, cardiology, rheumatology, immunology with allergology.
Fluent in general clinical methods for the diagnosis and treatment of heart disease, as well as electrocardiography, echocardiography, monitoring of cholera on an ECG and daily monitoring of blood pressure.
The treatment complex developed by the author significantly helps with cerebrovascular injuries and metabolic disorders in the brain and vascular diseases: hypertension and complications caused by diabetes.
The author is a member of the European Society of Therapists, a regular participant in scientific conferences and congresses in the field of cardiology and general medicine. She has repeatedly participated in a research program at a private university in Japan in the field of reconstructive medicine.