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Medical science
Dergunova Galina Evgenievna, Tashkent Pediatric Medical Institute E-mail: [email protected]
PECULIARITIES OF CLINICAL SYMPTOMATICS OF NONREVMATIC CARDITIS IN CHILDREN OF PRESCHOOL AGE ON THE BACKGROUND OF RESPIRATORY DISEASES
Abstract: The article describes the features of the development of myocarditis among 88 children aged 1-7 years with myocarditis. On the basis of clinical and laboratory data revealed that contribute to the development of carditis virus, viral and bacterial infections, chronic foci of infection, allergy. Children 1-3 years carditis develops in the early stages, in the acute phase of infection, occurs in moderate and severe forms. Children 4-7 years revealed signs of carditis 15-20 days later after a previous infection, occurs in moderate and mild forms. Therapy, clinical supervision promote rehabilitation of children, prevent chronization carditis.
Keywords: myocarditis at children; diagnostics; therapy.
Diseases of myocardium non-rheumatic genesis are one of the most common pathologies of the heart in children. Infectious diseases are the most common pathology of childhood, against which the cardiovascular system is involved in the pathological process. Approximately 1-5% of patients with acute viral infection may have myocardial damage [2; 4; 5]. Almost all known infections can cause myocarditis. Most often, carditis develops in a viral, viral and bacterial, rather than monoinfectious process, there are allergic carditis (drug, serum, vaccine-free), toxic (with diphtheria), toxic-allergic, carditis with progressive muscular dystrophies, diffuse diseases of the connective tissue (collagenosis), as a result of myocardial damage by physical, chemical and biological agents and, finally, a large group of idiopathic carditis [1; 3]. Clinical manifestations of the disease, in general, are not specific. Manifestations of myocarditis can vary from mild forms without signs of heart failure to the clinical picture of severe circulatory failure, complex arrhythmias and conduction disorders [4].
Objective: the clinical features of non-rheumatic carditis in preschool children, depending on age.
Material and research methods. The study included 88 children aged 1 to 7 years who were diagnosed with non-rheumatic carditis. In the group of observed young children (1-3 years old) there were 48, adolescent children (3-7 years old) - 40 people, the observation was carried out over 2 years.
For the diagnosis of myocarditis, the criteria proposed by NYHA (New York Heart Association, 1973) were used, where large criteria were highlighted (infection, signs of disease within 10 days after it, congestive heart failure, cardiogenic shock, complete AV blockade, changes on ECG, increased activity of myocardial enzymes) and small criteria (laboratory confirmation of a viral disease suffered, tachycardia, weakening of the first tone, canter rhythm, results of a subendomyocardial biopsy s). The history and combination of two large or one
large plus two small criteria are sufficient for establishing the diagnosis.
Results. In infants, in 8(16.5%) cases, myocarditis was diagnosed upon admission to hospital with a diagnosis of acute respiratory disease, acute pneumonia against the background of acute manifestations of the underlying disease, in 30(62.5%) children myocardial lesions were diagnosed through 10-14 days in the period of convalescence after acute respiratory illness, in 10(21%) children - 15-20 days after the illness.
In adolescent children, the diagnosis of myocarditis in 30 (75%) cases was diagnosed after the illness after 15-20 days, in 9 (22.5%) after the cases 20-30 days after the illness, only in 1 case (2.5%) myocardial damage was diagnosed in the period of acute respiratory disease.
36 children (41%) were diagnosed with chronic foci of infection (chronic tonsillitis, sinusitis, caries), of whom 10(21%) were under the age of 3 years old, and the remaining 26(65%) were between the ages of 3 and 6 years old.
Clinical manifestations of the disease, in general, are not specific. Children become lethargic, restless, moaning at night, decreased appetite, sometimes nausea and vomiting. Often there is an obsessive cough, aggravated by changing the position of the body. Join cyanosis, shortness of breath.
The borders of the heart in acute diffuse carditis in most cases are extended moderately. Apical impulse weakened. During auscultation, there is a muffled or deafness of tone I at the apex; moreover, the larger the heart is, the wilder the tone is. II tone above the pulmonary artery is enhanced. The canter rhythm is often heard with cardiomegaly. Systolic murmur is not typical, it is heard in half of the children with acute carditis, and is functional. Rhythm disturbance in the form of tachycardia, less often bradycardia. Manifestations of myocarditis can vary from mild forms without signs of heart failure
PECULIARITIES OF CLINICAL SYMPTOMATICS OF NONREVMATICCARDITIS IN CHILDREN OF PRESCHOOL AGE ON THE BACKGROUND OF RESPIRATORY DISEASES
to the clinical picture of severe circulatory failure, complex arrhythmias and conduction disorders.
In young children, non-rheumatic carditis occurred in 2(4%) cases in severe form, in the rest (46-96%) cases - moderately severe. In adolescent children, the majority of children (20-50%) had carditus of moderate form, 1(2.5%) of the child had a severe form, and 19(47.5%) children had a mild form.
ECG changes were characterized by changes in the ST segment and the T wave in standard or chest leads (V4-6), while in the course of the disease a certain dynamics was observed. In the first days of the disease, a decrease in the ST segment was observed with a simultaneous decrease in amplitude or flattening of the T wave (sometimes these changes quickly disappeared). From the 2nd, 3rd week of the disease, negative, often pointed T waves appeared. Later, the ECG changes gradually normalized, but sometimes persisted for several months. In 18(20%) children, extrasystoles were recorded (from single to bi- and trihymenias), which disappeared in the dynamics of
treatment. In 8(9%) cases, a violation of intraventricular conduction was determined according to the type of incomplete blockade of the bundle of the His bundle. In case of suspected heart rhythm disturbances that were not recorded at rest, it was monitored daily.
When echocardiography revealed concomitant pericarditis in 4 patients, it is possible to conduct a differential diagnosis with similar diseases occurring (valve defects, car-diopathy, etc.).
Findings
1. In young children, non-rheumatic carditis develops earlier: in the acute period of the underlying disease or in the period of early convalescence, it occurs in moderate and severe forms with signs of heart failure.
2. In adolescent children, signs of heart damage are detected after 15-20 days, in some cases within 1 month after the illness and only in isolated cases in the acute period of respiratory illness, it occurs in moderate and mild forms.
References:
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4. Ruzhentsova T. A., Gorelov A. V., Smirnova T. V., Diagnosis L. A. and treatment of myocardial infectious lesions in children // Infectious diseases. 2012.- No. 2.- P. 62-66.
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