Symptoms and diagnosis
Clinical symptoms and diagnosis can be clearly expressed, under expressed or almost non-existent.
Start can be acute with fever, migratory poliarthritis, weakness, sweating, dyspnea at movement, abdominal pain, swelling around the ankles, palpitations. Physical examination may determine that the apex of the heart is moved laterally from medioclavicular lines, diffuse. There is tachycardia and during the day and during sleep of patients and occurs in more severe and is usually a bad prognostic sign.
Heart sounds are muffled. You can hear the rhythm of the gallop (gallop protodiastolic). Extrasystolic arrhythmias are common, especially during physical activity. Atrial fibrillation is rarely seen. Phlebography jugular vein may show a pronounced wave of Berheimovog effect of the right ventricle, and pronounced v wave due to functional insufficiency trikuspidalnih valve when the heart is considerably enlarged.
About 5% of these patients will stagnans and heart failure. These are the most severe forms of acute rheumatic fever with carditis. More frequent in patients in whom acute rheumatic fever began gradually, with low temperatures and arthralgia for several weeks, but the children in which the disease started acutely with high fever and stiff joints.
The most common symptoms are: fatigue, sweating, loss of appetite, shortness of breath, coughing, chest pain, palpitation and epigastric pain. Physical signs vary and depend on the degree and duration of heart failure. The initial sign may be tachypnea. However, if it is a child, and if receiving salicylates, which can cause tachypnea, should be careful in assessing tachypnea as a sign of heart failure. In the lungs can be heard bronchogeny, wet litter in lung bases. Auscultation of the heart, in addition to tachycardia, hear the muffled tones and protodiastolic gallop.
The veins in the neck may be swollen, and there is tenderness in the right hypochondrium due to an enlarged liver that can tap under your upper abdomen. Sometimes there is a light facial fullness and swelling leg.
Radiological signs of
At radiological examination the heart is increased, more or less as a whole. Due to Brake heart failure is very pronounced hilus patterns. In pulmonary edema there confluent, inhomogeneous shadow in the upper and middle lung outside.
ECG signs of
The most common finding was prolonged PR interval, and occurs in about 25% of patients with acute rheumatic myocarditis. As the prolonged PR interval (or degree AV block) happiness in other pathological conditions, it should not be understood as a specific manifestation of rheumatic. Clinical symptoms and diagnosis of acute rheumatic fever, are in favor of acute rheumatic myocarditis.
Rarely are observed: Weckebachova periodicals, AV dissociation, complete AV block and nodal rhythm.
QT interval (electric systole) was extended, but it can not be taken as a sure indicator of acute carditis, or is in direct correlation with inflammatory changes in the myocardium.
Functional signs
Acute changes in diffuse inflammatory nature in the myocardium lead to less or more pronounced heart failure and delays. Cardiac output is reduced, there are signs of a halt to the lungs and in the field of large hollow veins.The patient was because of this and because of changes in the joints forced to lie in bed. If stagnans heart failure patients is more pronounced orthopnea and takes spolusjedeći iil sitting spoložaj.
If acute rheumatic myocarditis associated with endocarditis and pericarditis (pankarditis), signs of impaired hemodynamics are most pronounced.
Laboratory signs of
SE is accelerated. There is anemia, leukocytosis, increased alpha-2 globulin and fibrinogen in plasma. There is a C-reactive protein. In some patients leads to increased SGOT (AST) and SGPT (ALT) and lactic dehydrogenase increased (LDH), and alpha-1 glyco-iproteina.
Bacteriological and immunological findings
Group A beta-hemolytic streptococci are rarely isolated from throat swab culture. ASTO titer increased.Imunoelectroforesis shows is an increase of IgA globulin in about 70% of cases. The first days and weeks, and increased serum complement. Special techniques and methods of examination can be detected in the serum, circulating antibodies directed against heart tissue.
The minimal diagnostic program
Symptoms and diagnosis of acute rheumatic myocarditis is on the basis of data on the recent history of acute tonsillopharyngitis, acute migratory polyartritis interventions that mainly large joints, appears systolic functional character of forests at the top, tachycardia, gallop rhythm, tone muklih, rapidly, ASTO titer increases in serum , increase in alpha-2 globulin electrophoregram, extending PR and QT intervals, appears isorytmic dissociation or nodal rhythm on ECG and cardiac enlargement on X-ray shadow-in.
In some children the clinical picture is rarely seen. The child is usually pale, no appetite, cheerless, with arthralgia and myalgia, pronounced weakness, tachycardia, quiet heart sounds, gallop rhythm, functional sistolmm trees at the top, rapidly, anemia, leukocytosis, elevated ASTO titers, increased concentration of fibrinogen in plasma, and increased alpha-2 globulins in the electrophoregram. Rtg: cardiac shadow is enlarged, there is sometimes a delay in the hilum and the lung.
ECG: may be prolonged PR and QT interval, and the happiness and isorytmic dissociation and nodal rhythm.
Forecast
Acute rheumatic myocarditis leads to scars in the myocardium.
In some cases these changes are not so diffuse as to be in other cases. You, the easiest cases, clinical not show almost no signs of acute myocardial rheumatoid rniokarditisa. Sometimes it is just possible to see easily prolonged PR interval on ECG.
In other patients there is a diffuse change, enlargement of the heart and the occurrence of heart failure Brake. Aschoffovi nodules, which develop in the myocardium of patients and in 25% of these are clinically inactive cases, show signs of morphological evolution. This suggests that certain patients may evolute that subclinical, and the prognosis is poor in them. These patients should be under the constant, regular, controlled by doctors.
The prognosis of patients with acute rheumatic myocarditis is even worse if the clinical manifestations of myocarditis are more pronounced and more difficult of the first attack of acute rheumatic fever with carditis.
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