Carditis

Carditis – an inflammation of covers of heart of various localization and an etiology. The disease can affect an epicardium, an endocardium, a myocardium, and also a so-called pericardiac bag – a pericardium. Now the general term "carditis" as the disease can affect several covers of heart at the same time is used.

Carditis: etiology and pathogeny of a disease

The leading role in development of carditises belongs to infectious agents (the virus carditises provoked by Koksaki's enteroviruses, a virus of a herpes simplex, ESNO, a cytomegalovirus, a virus of a rubella, poliomyelitis, adenoviruses). Also bacterial, parasitic, fungal infections, allergic reactions become origins of a carditis. Allocate a carditis of idiopathic character at the unspecified reasons of development of inflammatory process.

The pathogeny of carditises is considered thus: the activator gets directly to heart tissues (an endocardium, a myocardium, an epicardium and a pericardiac bag – a pericardium), getting into myocytes (the special type of cells making a basis of muscular tissue) where there is its replication, namely, reproduction of activators is preferential at the expense of proteinaceous structures of a cell that significantly breaks functioning of cells owners. In response to infectious defeat production of interferon in an organism which interferes with further defeat of tissues of heart increases. Long reaction of an organism to implementation of the activator in tissue of heart is observed extremely seldom. In such cases it is about a latent, persistent invasion. As a rule, the activator is blocked and eliminirutsya shortly. During the rehabilitation period in the struck fabrics active synthesis of collagen which, being condensed and turning into fibrous fabric is observed, replaces the necrosis centers.

Not rheumatic carditis: classification, differentiation

Not rheumatic carditis – the inflammation of covers of heart caused by various factors except for rheumatism and other general diseases.

Rheumatism – system inflammatory process with the main center of localization in heart covers. A rheumatic carditis – the main manifestation of rheumatic process in an organism.

Not rheumatic carditises are diagnosed for patients of all age groups and a sex. However more often carditises are diagnosed at early age. Boys are more subject to risk of development of a carditis.

In modern medical practice classification of not rheumatic carditises by the emergence period, type of the activator, severity, character of a current, an outcome is provided.

On the period of emergence distinguish the inborn and acquired carditises. Inborn carditises are a consequence the postponed mother of a viral or bacterial infection. Early inborn carditises are result of the postponed disease on 4-7 weeks of pregnancy. The late inborn carditis develops as a result of the postponed infections in the third trimester of pregnancy. The acquired carditises occur at the child extremely seldom and are a consequence of the postponed acute infection (sepsis, flu, pneumonia).

As a current carditises are distinguished:

• Acute – duration of inflammatory process is up to 3 months;
• Subacute – duration of a carditis is up to 18 months;
• Chronic – lasting more than 18 months.

At diagnosis the carditis at children needs to be differentiated with a mitral stenosis, inborn heart disease, tumoral processes in heart, rheumatism, arrhythmias of a noncardiac origin.

Carditis at children: risks and complications

The carditis outcome at children depends on many factors from which distinguish genetic predisposition, the general condition of an organism, age of the child by the beginning of a disease, a condition of immunity, timeliness and efficiency of the picked-up therapy.

Possible outcomes of carditises are:

• Absolute recovery which it is possible to judge after 12-18 months since the beginning of a disease. At a chronic and subacute current of carditises the absolute recovery, as a rule, does not come;
• Arrhythmia – the complication at a carditis at children which is characterized by permanent disturbance of cordial rhythms. Quite often this complication is a cause of death of children at chronic forms of carditises;
• The cardiosclerosis and hypertrophy of a myocardium – at such complications carditises at children are characterized by heavier current, is frequent with a lethal outcome;
• Pulmonary hypertensia – change of vessels of the pool of a pulmonary artery of resistant character that worsens the forecast of a disease.

Carditis: symptoms of various types

At a carditis symptoms will depend on an etiology of a disease, time of its emergence and a form.

At the acquired acute and subacute carditis symptoms can initially have noncardiac character (the heart which are not caused by dysfunction) which treat:

• Hyporexia;
• Slackness, bystry fatigue, irritability;
• Nausea, vomiting.

The symptomatic complex of carditises can be added with symptoms of the infection which caused a disease: skin reddenings and rashes, orchitis, mialgiya. In process of pathology of a carditis, symptoms are supplemented with symptoms of heart failure (short wind, tachycardia, arrhythmia). Children at early age have a concern, cough. Pain in heart about which the child cannot report yet, is determined by reaction of the child to the movements of his body (the child reflex avoids sharp movements, cries at the movements), and also by shallow breathing (the movement of a thorax at a breath causes painful feelings that provokes the child to limit significantly breath depth). At a chronic carditis symptoms can not be shown long time. The clinical picture is supplemented with the suffocating cough amplifying in a prone position, crimson cyanosis of cheeks, lips, palms, nails.

Carditis: treatment of a disease

At a carditis treatment demands an integrated approach. Its tactics will depend on the reasons of development of a carditis, prescription of a disease, character of a current of a carditis. At an acute carditis treatment needs to be carried out in the conditions of a hospital. At remissions of a carditis treatment is carried out on an outpatient basis. The main medicamentous drugs used in treatment of carditises are cardiac glycosides, diuretics, hormonal drugs. At an acute current of a carditis the high bed rest, restriction of the used liquid (its quantity has to be less than the emitted urine), an adequate diet with restriction of salt and increase in a share of the products containing potassium (potatoes, raisin, dried apricots) is shown to patients.

The physiotherapy exercises, during the remission periods are often applied, on the contrary, exercise stresses are contraindicated (release from physical culture at school, the additional day off is recommended).

After the postponed carditis carrying out preventive inoculations in the first 3 – 5 years is contraindicated. At timely diagnosis and the correct tactics of treatment of carditises the forecast favorable.