Myocardial damage syndromes in children. Acute myocarditis in children. Features of the clinical picture in a child over two years old

Myocarditis is an inflammatory disease of the heart muscle of various etiologies. Myocarditis occurs quite often, sometimes has an unfavorable course. Especially if it is myocarditis in newborns. Treatment of the disease also requires increased attention.

Myocarditis in children most often develops due to infections. In these cases, it may be accompanied by symptoms of endocarditis. Very rarely, myocarditis is observed with allergies in children. Sometimes myocarditis is congenital.

Clinical picture

Infectious myocarditis, as a complication, can occur in children both during infection and during the recovery period. The child may have no symptoms - manifestations of myocarditis are changes in percussion, auscultation and changes in the ECG. Acute myocarditis in children has a particularly severe course.

Changes in the heart in children manifest themselves at the onset of the disease as an increase in size, dullness of tones and the appearance of systolic murmur (). Only with severe myocarditis may the child have symptoms of heart failure.

Myocarditis in newborns is manifested by difficulty in feeding. There may also be symptoms: anxiety and agitation, increasing over time, increased sweating.

In older children, the first symptoms to appear are weakness, weakness, abdominal pain, sometimes accompanied by nausea or even vomiting, and fainting. Characteristic signs of heart failure in children are cough, rapid or difficult breathing, marbled skin color with cyanosis, weak pulse, symptoms of hypovolemia (cold hands and feet, decreased venous pressure).

Depending on the mechanism of injury and type, the symptoms of myocarditis in children may vary.

Features of the clinical picture for different types of inflammation

• Viral myocarditis in children it very often occurs as myopericarditis, i.e. with simultaneous damage to the pericardium - the pericardial sac. Enlargement of the heart, dullness of tones, and changes in rhythm are observed. With enteroviral etiology, the child may present with neurological and gastrointestinal symptoms. With timely treatment, recovery occurs quickly.
• Infectious myocarditis of bacterial nature occurs in school-age children and occurs in a moderate form with muffled tones, systolic murmur, and changes in the ECG. The current is favorable. Often inflammation of the muscle membrane occurs with symptoms of infective endocarditis (see below).
• Allergic myocarditis occurs in children after administration of drugs, vaccines, serums, transplantation. Or it may develop as hypersensitivity to infection. In this case, the disease is called infectious-allergic myocarditis. With this type of damage to the heart muscle, in addition to heart complaints, allergic manifestations are also present.
• Idiopathic myocarditis Abramov-Fiedler(idiopathic - the cause is not clear) - a special form of myocarditis. It begins acutely with symptoms of shortness of breath, a sharp deterioration in condition, pale skin with cyanosis, rapid heartbeat, rhythm disturbances, and an increase in the size of the heart.

Myocarditis in newborns often occurs in the form of endocardial fibroelastosis, the cause of which in children is not fully understood. There is an assumption that this type of myocarditis occurs as a result of intrauterine infection. Myocarditis begins to develop in the first month of life: children develop shortness of breath and frequent respiratory tract infections with obstruction. There is a delay in body weight gain and an increase in heart size. The prognosis, unfortunately, is unfavorable in most cases.

Endocarditis

The concept of infective endocarditis refers to inflammation of the inner lining of the heart. It occurs due to damage to the membrane by streptococcus or staphylococcus. Predisposing factors for the development of infective endocarditis are decreased immunity, the presence of foci of infection in the body, and endocardial trauma.

The clinical picture of infective endocarditis consists of symptoms of damage to the inner membrane, intoxication and thromboembolic complications and undergoes several phases of development.

• The infectious-toxic (initial) phase of infective endocarditis is manifested by symptoms of intoxication: fever, chills, sweating. After some time, signs of valvular damage appear (changes in heart sounds over the affected valves). Thromboembolic complications begin to appear.
• The immunoinflammatory phase of infective endocarditis occurs with the deposition of immune complexes. Externally, this is manifested by painful Osler nodes on the fingertips, erythematous painful Janeway spots on the palms and soles, small areas of hemorrhages with a white spot in the center (Liberman-Lunin spots), retinal hemorrhages (Roth spots), subungual hemorrhages.

During this phase of infective endocarditis, anemia develops, an enlargement of the spleen occurs, and abacterial damage to the liver, kidneys and pancreas occurs.

In the dystrophic phase of infective endocarditis, cardiac, renal and liver failure develops. This phase is irreversible and incurable.

Therapeutic measures

Treatment of myocarditis in children is aimed at combating heart failure.

• If an immunological mechanism is present, then anti-inflammatory treatment of myocarditis is carried out with non-steroidal anti-inflammatory drugs (diclofenac, aspirin, etc.).
• In case of vascular damage, myocarditis therapy includes drugs to improve microcirculation (heparin, trental, chimes).
• For bacterial etiology of myocarditis, therapy is carried out with antibiotics based on the sensitivity of the pathogen.
• During the recovery period of myocarditis, treatment is carried out with cardiotrophic drugs (neoton, carnitine, etc.) and vitamins.
• In the presence of heart failure, myocarditis is treated with cardiac glycosides.

Treatment of endocarditis is based on the influence of the pathogen through the use of antibiotics and sanitation of foci of infection.

If inflammation progresses and treatment measures are ineffective, surgical treatment is indicated.

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.

1. 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.
2. 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.

1. The lack of specificity of signs of the disease often leads to a delayed diagnosis and the onset of heart failure.
2. Autoimmune diseases, which can affect not only the heart, affect inflammation either only of the myocardium, or of all the cardiac membranes.
3. Myocarditis suffered in childhood can influence the development of cardiomyopathy. This disease is irreversible. The only chance for recovery will be an organ transplant.
4. There is no 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.

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

• enteroviruses;
• some viruses;
• herpes;

1. 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.
2. 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.
3. 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.
4. 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

1. 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.
2. 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.
3. 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.

1. If you have previously had a bacterial infection, then antibiotics are prescribed, in particular Penicillin and Monocycline.
2. If the disease was viral, antiviral drugs are prescribed, in particular Interferon or Ribavirin.
3. Immunomodulators, for example, Transfer Factor Cardio, may be prescribed.
4. In order to improve myocardial function, gamma globulin is administered intravenously.
5. Nonsteroidal anti-inflammatory drugs, for example, Butadione or Voltaren, may be prescribed.
6. If there is prolonged pain, Anaprilin is prescribed in a minimal dose.
7. Hormonal agents have antiallergic and strong anti-inflammatory effects.
8. If myocarditis is in a fairly advanced form, Prednisolone or Dexamethasone is prescribed.
9. For autoimmune myocarditis, hormonal therapy with the use of potassium-containing products will be prescribed.
10. If heart failure occurs, Dopamine is prescribed.
11. If swelling is present, use a diuretic, in particular Fonurit, as well as a sugar-free diet.
12. Vitamin therapy is mandatory, especially taking representatives of group B and vitamin C.
13. If there are signs of arrhythmia, appropriate medications are prescribed.
14. It is important to exclude the possibility of hypothermia and transfer the child to a special physical education group, therefore, reduce physical activity.
15. 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

1. The child should be given exclusively steamed meals.
2. Meals should be fractional, six times a day, in small portions.
3. 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.

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

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

1. Products that need to be limited include:

• fresh bakery;
• baking;
• chocolate.

1. You need to completely exclude:

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

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

Prevention

1. Timely examination of a woman before pregnancy and compliance with precautions during pregnancy are of great importance.
2. Prevent your baby from coming into contact with sick people.
3. Get vaccinated on time and follow the vaccination schedule. During a flu epidemic, also get the appropriate vaccination.
4. If chronic diseases occur, in particular, or, stop them in a timely manner.
5. If you have any complaints about your health, consult a doctor in a timely manner and follow all his recommendations.
6. If there is an infectious process in the baby’s body, limit his physical activity.
7. 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 of feeling unwell. Be aware of the possible complications of myocarditis. At the first suspicion of heart problems, consult a doctor, do not delay.

Inflammatory processes in the heart are most often either complications of infectious diseases or a consequence of autoimmune processes. In any case, such phenomena in a child pose a serious danger to his normal life and health. Myocarditis in children is a pathological inflammatory process in the heart muscle.

There are congenital forms of the disease, when a child becomes infected in utero from the mother, as well as acquired forms of the disease, which are a consequence of the activity of a number of viruses, bacteria and fungi that enter the body of children, as well as a consequence of rheumatological (autoimmune) processes. Particular attention to myocarditis is associated with several features of its course in childhood, namely:

1. Nonspecific symptoms of the disease can lead to late diagnosis of the disease and the development of heart failure.
2. There is a relationship between myocarditis experienced in childhood and the occurrence of irreversible cardiomyopathy, the only effective treatment for which is a heart transplant.
3. Inflammation of only the myocardium, or all the membranes of the heart (panmyocarditis) is characteristic not of the common acute rheumatic fever, but of more rare and insidious autoimmune processes that affect not only the heart.
4. There is no specific etiotropic treatment for most forms of myocarditis. Therapy is based on symptomatic and pathogenetic treatment, as well as maintaining the activity of the child’s immune system at the proper level.

Unlike the same disease, but developing in adult patients, in children under 2 years of age it is often not possible to identify complaints and symptoms of the early stages due to the inability to speak. Also, for children of any age, myocarditis can become a sudden and serious illness that poses an immediate threat to the life of a small patient.

Considering that most often such an illness occurs as a complication of influenza and ARVI, every parent should be attentive to the treatment of even such seemingly mild and trivial infections.

Causes of the disease

Infectious myocarditis in children is a consequence of exposure to the body of the following groups of pathogens that enter the myocardium either in utero or as a result of complications of the infectious process:

• Viral infection. It is considered the cause of myocarditis in most cases. Proof of this is the study of myocardial biopsies, which reveal specific inflammatory changes. The most common causes of myocarditis in children are enteroviruses, influenza A and B viruses, a group of viruses that cause ARVI, measles, rubella, mumps, chickenpox, herpes, etc.
• HIV infection, which is transmitted from mother to fetus through the placenta (vertical transmission). Against the background of immunodeficiency, any of the microorganisms can almost easily infect the myocardium of a newborn.
• Protozoa microorganisms(chlamydia, mycoplasma, etc.). Most often, a child becomes infected with such infections during childbirth from the mother. In adolescents, the presence of such an infection may be associated with early onset of sexual activity.
• Lyme disease, which occurs after a tick bite. A child may be exposed to tick bites as a result of playing outdoors or being in the forest. If this disease is not prevented, its causative agent (bacterium of the genus Borelia) can enter the myocardium and provoke its inflammation, combined with damage to the skin and joints of the child.
• fungal infection, which, against the background of a severe bacterial or viral disease in a child, as well as in AIDS, circulating in the blood, can cause myocarditis. Particular attention is paid to fungi due to the need for treatment with specific drugs with pronounced side effects, especially pronounced in relation to the liver.
• Sometimes non-rheumatic myocarditis in children is difficult to associate with an infection or an autoimmune process. In this case, the disease is designated as idiopathic, i.e. with unclear etiology. However, upon more detailed analysis of the myocardial biopsy (which is performed extremely rarely due to the invasiveness of the procedure), traces of rare viruses or protozoa are found in such patients.

Rheumatism, which occurs against the background of chronic tonsillitis caused by β-hemolytic streptococcus of group A, leads to damage to the inner lining of the heart - the endocardium. But in some cases, such an autoimmune inflammatory process affects all the membranes of the heart, incl. and myocardium, causing myocarditis.

Symptoms of myocarditis in children

The main symptoms of myocarditis in children are similar to other pathologies of the heart and lungs, which complicates the initial diagnosis. These signs include:

1. Moderate or mild pain in the heart area.
2. Signs of an infectious process are increased body temperature, fever, sweating, weakness, and a feeling of malaise.
3. Shortness of breath at rest, swelling of the extremities and other mild symptoms of heart failure.
4. Feeling of interruptions in heart function, arrhythmic pulse. Tachycardia (acceleration of heart rate) or severe bradycardia (slowing of heart rate) is observed.

Often, early symptoms of the disease are difficult to diagnose and are detected against the background of general signs of infection or an “attack” of a rheumatological disease. It is customary to distinguish 3 forms of myocarditis in children: acute, subacute and chronic.

Diagnosis of the disease

Acute myocarditis in children is diagnosed by a doctor according to the following algorithm:

• General examination of the child and detailing of all his complaints (for young children - complaints of his parents).
• Carrying out auscultation of the heart and lungs, as well as percussion in order to determine the boundaries of the heart and lungs. These studies will allow the doctor to determine the muffled, arrhythmic heart sounds characteristic of myocarditis, and the expansion of its percussion boundaries.
• General clinical blood test allows you to clarify the type of inflammatory process (bacterial, viral or allergic).
• General clinical urine test allows you to assess the presence of urogenital infection, as well as assess kidney function, which is very important during exacerbation of autoimmune processes in a child.
• Ultrasound of the heart (EchoCG). This study allows us to confirm dilatation (expansion) of the atria and ventricles, and also, based on changes in the echostructure of the myocardium, to suggest the presence of inflammatory changes in them.
• Serological studies of blood plasma make it possible to identify antibodies against specific infectious agents (a number of viruses, bacteria and protozoa) that can cause myocarditis in children.
• Diagnosis of concomitant disease allows you to establish the true cause of heart damage or, on the contrary, refute the connection with other diseases.

With systemic lupus erythematosus, juvenile rheumatoid arthritis, and autoimmune thyroid disease syndromes, concomitant inflammatory damage to the myocardium can develop.

Myocarditis may also be associated with the toxic effects of ethanol and other chemical compounds on the myocardium, or with uncontrolled use of medications as part of self-medication.

The diagnosis of infectious, rheumatic or toxic myocarditis is made based on a combination of complaints, identified symptoms of pathology, as well as the results of laboratory tests. It is this comprehensive approach to diagnosis that allows you to establish a diagnosis as quickly as possible and begin appropriate treatment.

Determining the true cause that provoked the disease in a child will allow the doctor to prescribe more effective treatment and recommend preventive measures to prevent the development of such a pathology in the future.

Treatment of myocarditis in childhood

Symptoms and treatment of myocarditis in children depend on the cause and form of the disease. In case of an infectious cause, the following groups of drugs are used:

1. For viruses – general restorative antisymptomatic therapy. In the case of influenza, antiviral drugs are used (rimantadine, oseltamivir, etc.). In the case of chickenpox, herpes, CMV - the antiviral drug acyclovir and its derivatives. If the course of the viral infection is very severe, and a specific antiviral drug has not been developed, drugs from the interferon group, as well as special antiviral immunoglobulins, can be used. Often they have to be resorted to in severe cases of childhood infections such as measles, rubella, mumps, etc.
2. Antibacterial drugs are used against bacteria (after identifying the pathogen by microbiological or serological methods), taking into account the sensitivity of the pathogen to them. In the case of myocarditis due to Lyme disease, which occurs as a result of a tick bite and is accompanied by a pronounced clinical picture, treatment with doxycycline begins immediately.
3. Protozoa microorganisms are also treated with antibiotics, taking into account the sensitivity of the pathogen.
4. Against fungal infection use special antifungal drugs (amphotericin B, etc.).

Treatment of rheumatic myocarditis is carried out with the following groups of drugs:

• Non-steroidal anti-inflammatory drugs.
• Glucocorticosteroids according to special regimens.
• Immunosuppressants for very severe cases of the process.

To alleviate the child’s condition, he is prescribed bed rest for the entire duration of treatment, antipyretics, plenty of fluids, and a special diet rich in proteins, carbohydrates and vitamins. Diuretics can be used to relieve heart failure.

An important condition for recovery in childhood is not only competent etiotropic therapy, but the creation of conditions under which the cardiovascular system will not experience stress, while the body fully receives supportive treatment and dietary nutrition.

The insidiousness of pathology: myocarditis in a child updated: February 24, 2017 by: admin

What is myocarditis in children? The article will answer how dangerous this disease is and what treatment methods exist. Parents will be able to find out more information about the causes of this disease, the first signs and effective methods of treatment.

Myocarditis is the occurrence of inflammation in the heart muscle. In children, it appears after a variety of infectious diseases and during severe allergies. Congenital myocarditis in children has the following symptoms: shortness of breath, pallor and weakness.

In this case, the doctor usually determines muffled heart sounds and tachycardia. With the acquired disease, nausea and vomiting may occur. There are many causes for this disease and most often it affects boys. The disease most often affects children 4-5 years old and adolescents.

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:

1. Infectious and toxic.
2. Immune or allergic.
3. Toxic-allergic.
4. Unexplained nature.

According to the course, myocarditis is classified into acute, chronic and subacute. Symptoms vary greatly between species.

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. To determine the viral etiology, the blood is checked and antibodies to viruses are examined. Treatment is prescribed only after an accurate diagnosis has been made.

Treatment

In case of acute myocarditis, children are treated in a hospital setting. 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. This disease is dangerous for infants, but with effective treatment, complete recovery is possible.

School-age children tolerate myocarditis more easily. With chronic disease, relapses often occur, which lead 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 a mild form of the disease 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:

1. 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.
2. Drug treatment of a viral disease involves taking cardiac glycosides, diuretics and ACE inhibitors.
3. For rheumatic myocarditis, non-steroidal anti-inflammatory drugs, as well as glucocorticosteroids, are prescribed.
4. When treating an allergic type of disease, the allergen should be immediately eliminated. Antihistamines are also used.
5. 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 an infection that has arisen in the body: chronic tonsillitis, inflammation of the 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 he often breaks for rest.

Worrying symptoms include increased moodiness and decreased 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:

1. Increasing the overall standard of living.
2. Maintaining a healthy lifestyle.
3. Healthy and nutritious nutrition, hardening and use of vitamin complexes.
4. Isolation of patients from schools and kindergartens was carried out in a timely manner.
5. Complete treatment of any emerging diseases.
6. 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. Following simple rules will help your child stay healthy and avoid myocarditis.

Thank you

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!

What is myocarditis?

In order to understand what myocarditis is, you need to know the structure and functions of the heart. Heart is a muscular organ that ensures the delivery of oxygen to all tissues and organs of the body. This body consists of four main sections ( cameras) - left ventricle, left atrium, right ventricle and right atrium. The chambers are separated from each other by fibrous partitions. The heart can also be conventionally divided into left and right sections.

Damage to these departments is accompanied by heart failure. Therefore, if the left chambers of the heart are affected ( mainly the ventricle), then they talk about left heart failure, if the right part - about right heart failure.

In the structure of the walls of the heart, there are three main layers - outer, intermediate and inner. The intermediate middle layer is called the myocardium. This is the most powerful layer of the heart and is represented by striated cardiac tissue. This tissue is not found anywhere in the body. Myocardial cells are called cardiomyocytes.

Etiology ( origin) myocarditis

Depending on the etiology, there are many types of myocarditis. However, some experts conditionally divide all myocarditis only into rheumatic and non-rheumatic. The first include damage to the heart muscle during rheumatic fever ( or rheumatism), to the second – all others. The main difference between these two groups is that with rheumatic carditis there is damage to both the myocardium and endocardium ( inner lining of the heart). The consequence of this is damage to the heart valves with further development of valvular insufficiency.

Causes of myocarditis

Cardiotoxic drugs include:

• Cyclophosphamide and other cytostatics from the group of alkylating compounds. When treated with cyclophosphamide, the heart becomes the main target. Acute heart damage can develop already in the first week of treatment.
• Rituximab and other drugs from the monoclonal antibody category. This group of drugs is currently actively used in the treatment of arthritis. However, it also has increased specificity for cardiac cells. When treated with rituximab, edema, infiltration, and damage to small vessels develop in the myocardium. The most common side effect of monoclonal antibody treatment is a sharp decrease in blood pressure ( acute hypotension) and arrhythmias.
• Interleukins also provoke heart rhythm disturbances ( arrhythmias, blockades) and hemodynamic disorders, in the form of decreased blood pressure. Interleukins also represent a new direction in pharmacotherapy - they are used in the treatment of many rheumatic diseases.
• Fluorouracil is a drug from the group of antimetabolites, which is widely used in the treatment of malignant neoplasms ( cancer). During treatment with this drug, constant monitoring of the electrocardiogram is recommended, since fluorouracil can cause spasm of the coronary vessels and provoke thrombosis. The result of this is a decrease in blood supply to the myocardium, that is, the development of ischemia.
• Sutent is an antitumor drug from the group of tyrosine kinase inhibitors. Can cause cardiac arrest, severe arrhythmias and blockades. However, changes that occur in the heart during treatment with this drug can disappear if the drug is discontinued in a timely manner.
• Pimozide, haloperidol and other antipsychotic drugs. They also cause changes in the functioning of the heart. Basically, these changes affect the heart rhythm and manifest themselves in blockages.

Pathogenesis of myocarditis

The mechanisms of myocarditis are:

• direct toxic damage to cardiomyocytes ( myocardial cells) – observed in alcoholic and toxic myocarditis;
• nonspecific damage due to generalized inflammation - characteristic of some systemic diseases;
• damage to myocardial cells during systemic infection – observed with viral myocarditis;
• cellular damage by immunological factors – observed when exposed to allergic factors.

Stages of myocarditis

The stages of myocarditis include:

• First stage– lasts from several hours to several days, depending on virulence ( aggressiveness) pathogen. It begins with the virus entering the body and fixating on myocardial cells. At first it clings to the surface of the cell, but very quickly penetrates into it. In response to this, the body activates its own reserves and produces antibodies to the virus. After the virus leaves the cell, antibodies and immune complexes continue to circulate in the body.
• Second stage ( autoimmune) – characterized by activation of inflammatory processes. Edema of the intercellular substance develops, and small vessels of the heart are affected. All this leads to the development of oxygen deficiency or myocardial hypoxia. Heart cells are very sensitive to lack of oxygen, so they begin to die quickly. Under conditions of oxygen starvation, the processes of collagenosis are activated ( synthesis of collagen fibers). Subsequently, collagen fibers begin to replace normal myocardial tissue. This phenomenon is called cardiosclerosis.
• Third stage– or stage of recovery. It is characterized by a decrease in cellular infiltrate, edema, and restoration of cardiac activity. The consequences of this stage depend on the degree of change that occurred in the second stage. Thus, the more extensive the growth of connective tissue occurs, the more myocardial contractility decreases. With massive cardiosclerosis, there is a decrease in cardiac function up to its complete loss.

Myocarditis in adults

Symptoms ( signs) myocarditis

• shortness of breath ( worsens after exercise and in a lying position);
• too frequent or, conversely, slow heartbeat;
• extrasystole ( type of heart rhythm disorder);
• weakness, fatigue, irritability;
• pale skin, sometimes with a bluish tint;
• swelling of the lower extremities, swelling of the neck veins ( at advanced stages);
• chest pain that is not relieved by nitroglycerin ( cure for heart pain).

The type of disease also affects the type and severity of symptoms. Thus, rheumatic myocarditis is characterized by a calm course without pronounced symptoms. Sometimes patients are bothered by chest pain without clear localization, mild shortness of breath that occurs after intense physical exertion. Idiopathic myocarditis, on the contrary, is characterized by a severe course with clearly defined symptoms. Patients suffer from severe heart pain, irregular heartbeat, and swelling of the legs.

Sometimes myocarditis occurs without any symptoms at all. As a rule, an asymptomatic course is typical for those cases when the disease develops on its own ( primary myocarditis), and not against the background of any pathology.

Variants of manifestation of myocarditis symptoms
As a rule, in the complex of symptoms that worry a patient with myocarditis, there are always several signs that prevail over the rest. Based on this, in medical practice there is a classification of the symptoms of this disease.

The following variants of manifestation of myocarditis symptoms are distinguished:

• Painful. It manifests itself as pain in the heart area, which is of a burning and/or squeezing nature.
• Arrhythmic. Patients experience interruptions in the functioning of the heart, namely its freezing, which alternates with increased heartbeat.
• Pseudovalve. This option is characterized by mild or moderate shortness of breath, an unknown type of pain in the heart, and general weakness.
• Thromboembolic. Patients are concerned about shortness of breath, a bluish tint to the skin on the fingers, in the area of ​​the nasolabial triangle.
• Decompensation. It manifests itself as painful rapid heartbeat, tinnitus, and decreased blood pressure.
• Mixed. In this case, myocarditis manifests itself in several of the above symptoms.
• Asymptomatic. This option is characterized by the absence or weak manifestation of any signs of the disease.

Pain due to myocarditis

Pain due to myocarditis occurs independently, without the influence of any external factors ( physical activity, stress). Unlike chest discomfort with other cardiac pathologies ( for example, with angina pectoris), pain due to myocarditis does not go away after taking nitroglycerin and other similar drugs.

Extrasystole

Classification of extrasystole
Extrasystole is classified according to such parameters as impulse localization, rhythm ( alternation of normal and extraordinary contractions), time of occurrence of extrasystoles.

The localization of the impulse refers to the part of the heart ( atrium or ventricle) in which the contraction occurs. Depending on this criterion, extrasystoles can be atrial, ventricular or atrioventricular. The most life-threatening is ventricular extrasystole, which has the most severe symptoms. With atrial or atrioventricular extrasystole, heart rhythm disturbances can only be detected during instrumental examination ( for example, with an electrocardiogram).

Heart rhythm during extrasystole, that is, the alternation of normal and extraordinary contractions of the heart muscle, can have several variants of manifestation.

The following heart rhythms are distinguished in this pathology:

• bigeminy ( the appearance of extrasystoles after every normal contraction of the heart);
• trigeminy ( the appearance of an extraordinary impulse after 2 normal contractions);
• quadrigeminy ( the appearance of extrasystole after 3 normal contractions).

How does extrasystole manifest?
When an extrasystole occurs, the patient feels a strong heartbeat, which may be accompanied by a feeling of anxiety or even panic. When describing their subjective sensations, patients use such definitions as “tumbling” or “turning over” the heart, a complete cessation of heart contractions for a while, a strong blow to the chest from the inside. At the same time, extrasystoles can rarely be determined by measuring the pulse, since only those impulses that occur during normal contractions of the heart reach the arteries.

In addition to subjective sensations during extrasystole, dizziness, headaches, and shortness of breath are observed, accompanied by a feeling of lack of air. When examining a patient, swollen, pulsating veins may be detected in the neck area. Frequent heart rhythm disturbances provoke deterioration of blood supply, which can cause nervous tics, severe headaches, and fainting.

Is myocarditis dangerous?

Complications ( consequences) myocarditis

The following are possible complications of myocarditis:

• cardiomegaly;
• myocardial cardiosclerosis;
• heart rhythm disorder;
• intracardiac thrombi;
• congestive heart failure.

Between the pericardium and myocardium there is a cavity ( pericardium), filled with fluid, which provides sliding movements to the heart during contraction. When the outer shell is inflamed, this cavity is filled with pathological contents ( which cells secrete during inflammation). Normally, this cavity holds no more than 30 milliliters of fluid, but with pericarditis the volume can increase 10 times. An enlarged heart sac puts stress on the heart, impeding blood flow, which in advanced cases can cause death. Also, filling this cavity with pathological contents can lead to pericardial rupture.

Like other inflammations, pericarditis can have acute and chronic forms. In the first case, the pericardial sac quickly fills with pathological contents, which causes severe circulatory disturbances and the threat of pericardial rupture. In chronic pericarditis, the cavity fills slowly, which reduces the intensity of complications that arise.

Based on the type of fluid that accumulates in the heart sac, pericarditis can be exudative or purulent. There is also a fibrous form of pericarditis, in which the pericardial cavity is filled not with fluid, but with fibrin ( protein tissue). Over time, the walls of the heart sac grow together, which increases the load on the heart and causes various complications.

The symptoms of pericarditis depend largely on the form ( purulent, fibrous, exudative) inflammation. With chronic inflammation of the outer lining of the heart, the symptoms appear more blurred, with an acute form - more vividly.

The following signs of pericarditis are distinguished:

• Pain in the heart area. Unlike pain with myocarditis, which occurs without the influence of external factors, with pericarditis the pain intensifies when lifting the head or torso up, when coughing, or when swallowing water or food. With the fibrotic form, patients complain of dull, pressing pain, with the exudative form – of sharp, sharp pain.
• Hiccups. This symptom is characteristic of all forms of pericarditis. The cause of hiccups is inflammation of the nerve located next to the pericardium.
• Difficulty swallowing. It is observed in the later stages of pericarditis and develops due to the fact that the heart sac begins to put pressure on the esophagus.
• Swelling of veins. With the exudative form, the veins enlarge on the patient’s neck, with purulent pericarditis - on the surface of the chest.

Cardiomegaly is a latent syndrome, that is, this problem does not have any specific symptoms. Therefore, pathology is detected only during examination. As with myocarditis, patients experience heart pain and shortness of breath, and heart rhythm is disturbed. Patients' resistance to both physical and mental stress decreases.

Therapy for cardiomegaly in some cases involves surgery. The purpose of the operation may be the implantation of special devices to regulate cardiac activity, prosthetic heart valves, bypass surgery ( expansion with a probe) cardiac blood vessels. In the absence of timely medical intervention, cardiomegaly can cause stroke, heart attack and other dangerous conditions.

Myocardial cardiosclerosis
With this pathology, the myocardial muscle tissue begins to be replaced by connective tissue ( fibrous dense fibers). Myocardial cardiosclerosis ( myofibrosis, cardiac sclerosis) always develops as a secondary disease against the background of myocarditis of bacterial, viral or allergic origin. Inflammation of the heart muscle entails pathological changes in the structure of the myocardial muscle tissue, which provokes the growth of fibrous cells that replace normal fibers. Healthy myocardial tissue is highly elastic, which allows the heart to contract. The appearance of fibrous areas leads to a deterioration in the contractile function of the heart, which provokes various types of arrhythmias.

Signs of myocardial cardiosclerosis are:

• feeling of heaviness and pain ( pressing) in the chest;
• paroxysmal cough;
• shortness of breath, feeling of lack of air;
• increased heart rate;
• constant fatigue, decreased performance.

Heart rhythm disorder
With prolonged myocarditis, various heart rhythm disturbances develop ( arrhythmias), which appear more and more often over time. This leads to the fact that maintaining a normal heartbeat becomes impossible without taking medications.

The following heart rhythm disorders may develop against the background of myocarditis:

• Tachycardia. In this condition, the heart begins to beat faster than usual, exceeding the norm, which is 90 beats per minute. A person feels a strong heartbeat, which may be accompanied by dizziness and anxiety.
• Flickering arrhythmia. With this pathology, the atria of the heart begin to contract chaotically ( flicker), and the contraction frequency can reach 300 per minute. The patient feels a strong “fluttering” of the heart, trembling, and fear. In some cases, prolonged attacks of atrial fibrillation can lead to fainting.
• Bradycardia. With this disorder, the contraction frequency is less than 60 beats per minute. Bradycardia is accompanied by severe weakness, the appearance of cold sweat, and semi-fainting.
• Heart block. With this problem, the heart rate is reduced to critical levels, which can lead to fainting, and in severe cases, sudden death.

Plugs can be localized in arteries, vessels or capillary beds. Blood clots are made from blood cells ( platelets, leukocytes, erythrocytes) and fibrin ( connective fibers). Blood clots can be static or moving. In the first case, they are attached to the wall and may have a stalk, which is why they resemble a polyp. Mobile formations move freely and are most often localized in the left atrium.

The symptoms that accompany an intracardiac thrombus largely depend on whether it moves or not. Thus, with immobile formations, people rarely detect any pathological changes in their condition. Sometimes the heartbeat may increase and shortness of breath may appear. With mobile blood clots, patients complain of frequent attacks of tachycardia, which are accompanied by the appearance of sticky cold sweat, sudden paleness or blue discoloration of the lips and fingers. Cardiac thrombosis is a serious complication of myocarditis, which, if left untreated ( often involves surgery) can cause death.

Congestive heart failure
With this pathology, the heart cannot cope with pumping the proper volume of blood necessary to ensure vital processes. Congestive heart failure ( ZSN) may be right-handed ( the functioning of the right ventricle is impaired) or left-handed ( left ventricular dysfunction). The disease develops in stages, going through 3 main stages.

The following features of the development of heart failure are distinguished:

• First stage. Manifested by shortness of breath, acrocyanosis ( blue fingers, nasolabial triangle), general weakness, cardiac arrhythmia. With right-sided heart failure, a person is also periodically bothered by pain in the area of ​​the right hypochondrium, swelling of the legs, and moderate thirst. In left-sided CHF, the main symptoms include problems such as a dry cough, expectoration of bloody mucus, and a feeling of shortness of breath at night.
• Second stage. All previous symptoms of the disease intensify and begin to bother the patient more often. Often at this stage, heart failure goes from unilateral to bilateral, since the healthy ventricle is also involved in the pathological process. In addition to the heart, the disease also affects other organs, most often the liver and lungs. Patients note dry or moist wheezing, asthma attacks, and pain in the liver area. Palpation reveals an enlarged liver. The examination reveals an accumulation of fluid in the peritoneum ( ascites), in the pleural cavity ( hydrothorax).
• Third stage. The final stage is characterized by a worsening of all the symptoms that accompanied the previous stages. To the existing problems is added the deterioration of the functionality of other body systems.

Prognosis for myocarditis

If myocarditis was aggravated by heart failure, then with adequate therapy, half of the patients experience a significant improvement in their condition until complete recovery. Number of patients achieving remission ( relief of symptoms), is 25 percent. In the remaining quarter of patients, the condition steadily worsens, even with treatment.

Giant cell myocarditis has an extremely unfavorable prognosis, since in the absence of surgical intervention the mortality rate reaches almost 100 percent. With diphtheria inflammation of the heart, the number of deaths varies from 50 to 60 percent. In most cases, the only effective treatment option for patients with these forms of myocarditis is heart transplantation.

Myocarditis in children

As in adults, viruses are the main cause of myocarditis in children. In children of the younger age group, the phenomenon of carriage of the virus is also observed, which significantly increases the risk of developing viral myocarditis.

The causes of myocarditis in children are:

• Viruses. The Coxsackie virus accounts for more than 50 percent of cases. The clinical picture of the disease is often very blurred, which makes diagnosis difficult. The disease develops after an enterovirus infection.
• Bacteria. Bacterial myocarditis is typical for infants. Their disease develops against the background of sepsis. In children of the younger age group ( up to 3 years) myocarditis can develop against the background of osteomyelitis. Bacteria that cause myocarditis include streptococci, pneumococci, diphtheria bacillus, and salmonella.
• Protozoa. This category of causes of myocarditis in children is less common than in adults. In this case, myocarditis develops against the background of toxoplasmosis or amoebiasis.

Development mechanism ( pathogenesis) myocarditis in children

In children, a distinction is made between congenital and acquired myocarditis. In the origin of the first group of myocarditis, maternal diseases, intrauterine infections, and placental pathologies play a large role. In the origin of acquired myocarditis, external factors play a major role.

Congenital myocarditis in children

Early congenital myocarditis
Early congenital myocarditis develops at 5–7 months of intrauterine development, as a result of which the child is already born with symptoms of the disease. During this period, the structure of the cardiac membranes - the pericardium, myocardium, and endocardium - is disrupted. Very quickly they are replaced by connective tissue, which leads to impaired contractility of the heart.

As a rule, children with congenital myocarditis are born with a deficiency of weight. The developmental delay continues after birth - children have difficulty gaining weight, and they are also stunted in growth. No specific cardiac symptoms are initially observed. Basically, nonspecific signs of heart failure attract attention - pallor of the skin, combined with cyanosis ( cyanosis), increased sweating. Such children, as a rule, are apathetic, passive, and get tired quickly. Congenital myocarditis quickly decompensates if the child becomes ill. It could be a common cold or pneumonia. In this case, shortness of breath, swelling, cough, and moist rales in the lungs appear ( due to stagnation in the pulmonary circulation). The examination reveals an increase in the size of the heart and muffled heart sounds.

The main diagnostic methods are electrocardiogram ( ECG), echocardiography ( EchoCG), chest x-ray. X-rays reveal an enlarged child’s heart, mainly due to the left side of the heart. Echocardiography shows a decrease in ejection fraction of up to 45 percent. Ejection fraction is the percentage of blood volume that is ejected from the heart into the blood vessels during one contraction. Simply put, this is the main indicator of the efficiency of the heart. Normally it should be 60 percent. A decrease in this indicator to 45 percent indicates severe heart failure. Therefore, the prognosis for early congenital myocarditis is disappointing. Most children die in the first months of life. With unexpressed changes, life expectancy can reach 10–15 years.

Late congenital myocarditis
Late congenital myocarditis develops after 7 months of intrauterine development, that is, during the third trimester of pregnancy.
In this case, children can be born both with the consequences of myocarditis and with the current disease. The clinical picture reveals rhythm and conduction disturbances in the form of blockades and arrhythmias. Children are lethargic, apathetic, and do not eat well. Upon examination, attention is drawn to frequent and shallow breathing, shortness of breath, pale skin, and cyanosis of the nasolabial triangle. Such children often experience damage to the central nervous system in the form of seizures. The combination of damage to the heart and nervous system often indicates a viral origin of the disease ( Coxsackie viruses are often involved).

If the process is acute, then laboratory blood tests show signs of inflammation. Regardless of the stage of the process, changes are noted on the electrocardiogram, x-ray, echocardiogram. The prognosis of late congenital myocarditis is more favorable and depends on timely medical care and the etiology of the disease.

Acquired myocarditis in children

Myocarditis after tonsillitis

With this pathology, a chronological pattern is revealed between angina and the appearance of the first signs of myocarditis. The clinical picture is very diverse and is characterized by a predominance of general intoxication syndrome. Isolated myocarditis after tonsillitis is rare. As a rule, it occurs in conjunction with other diseases, most often acute rheumatic fever. This is a systemic disease primarily affecting the cardiovascular system, which occurs in children from 7 to 15 years of age. Rheumatic fever develops against the background of an increased immune response to the presence of beta-hemolytic streptococcus in the body. This microorganism is the causative agent of purulent sore throat in 90 percent of cases. In addition to damage to the cardiovascular system, neurological symptoms and a ring-shaped rash are also noted.

As a rule, rheumatic fever debuts after 7–10 ( less often 14) days after a sore throat. The first symptoms are weakness, malaise, and a sharp increase in temperature to 38 degrees. Damage to the heart in this case is conventionally called rheumatic carditis and is manifested by shortness of breath, pain in the heart area, and rapid heartbeat. The difference between rheumatic carditis is that it occurs not only with myocardial damage ( the heart muscle itself), but also with the involvement of the connective tissue membrane of the heart in the pathological process ( endocardium). This is followed by pain in the joints, ring-shaped erythema, chaotic uncontrolled movements of the arms and legs ( chorea). Despite such a varied picture of the disease and its apparent seriousness, with timely treatment, changes in rheumatic fever are completely reversible. However, if treatment is delayed, changes in the heart can cause further heart failure. Basically, heart failure after tonsillitis is caused by damage to the mitral and/or aortic valve.

Diphtheria myocarditis

Myocarditis is a fairly specific symptom and/or complication of diphtheria. In turn, diphtheria is an acute infectious disease caused by Loeffler's bacillus. It mainly affects the upper respiratory tract - nasopharynx, larynx, lungs. As a rule, the disease is extremely severe. The reason for this is the action of the toxin that is secreted by the diphtheria bacillus. It is the toxin that affects the internal organs in diphtheria, sometimes leading to multiple organ ( multiple) insufficiency.

Diphtheria myocarditis occurs in the clinical picture of diphtheria in 25–30 percent of cases. Myocardial damage also occurs “due to” the action of diphtheria toxin. When the toxin enters the heart muscle, it first of all affects the conduction system of the heart and the nerve plexuses. This is explained by the fact that diphtheria toxin has increased sensitivity ( tropism) to the nervous system.
Damage to the conduction system of the heart causes cardiac arrhythmia, which is manifested by arrhythmias and blockades. Patients complain of rapid heartbeat, shortness of breath, and weakness. Pain in the heart also quickly develops, and the heart increases in size.

The main method for diagnosing diphtheria myocarditis is an electrocardiogram. It shows a displacement ( deprivation or elevation) ST segment, which indicates insufficient blood supply to the heart muscle ( that is, about ischemia).

Treatment consists of administering anti-diphtheria serum. Symptomatic treatment is also carried out, in which