Changes in the cardiovascular system in acute respiratory viral infections
Various early mechanisms may underlie the early development of circulatory disorders: 1) a disorder of the coronary circulation with hypoxia and anoxia;2) vasomotor disorders due to toxins;3) metabolic disorders, primarily hypokalemia and hypocalcemia.
As a result of these disorders and the influence of toxins, there is a degeneration of the fibers of the heart muscle. The pronounced dystrophy is observed in the nodes of the autonomic nervous system of the heart, which can be the cause of the development of acute heart failure. TI Ivanovskaya, A. V. Zinserling in a number of patients revealed focal myocarditis( circular cell infiltrates in the connective tissue of the heart).
Symptoms of .Patients complain of a headache, aches in the whole body, fatigue, decreased appetite, lethargy, fever to high or low-grade figures. Pale skin, intoxication, epicleritis, bright hyperemia of the pharynx, petechial hemorrhages on the skin and mucous membranes, white-lipped tongue, blue circles under the eyes are observed.
With early changes( at the height of toxicosis), there is an increase in blood pressure, tachycardia, muffling of heart sounds, extrasystole. With the timely administration of therapy, these symptoms disappear, which emphasizes their functional nature and connection with circulatory disorders in the myocardium.
Late changes( at the beginning of convalescence) reflect inflammatory and dystrophic processes in the interstitial tissue of the myocardium( often with damage to muscle fibers).They develop after an acute period, indicate significant disturbances in mineral metabolism.as a result of neuroendocrine disorders, appear after a decrease in body temperature and does not depend on the initial severity of the disease. Deterioration of state of health, sharp pallor of the skin, lethargy, tachycardia, lability of pulse are noted. The boundaries of the heart are shifted, systolic murmur on the left side of the sternum is heard, blood pressure is lowered.
Diagnostics and differential diagnostics .It is difficult to recognize influenza heart disease in young children, because its symptoms are often masked by signs of the underlying disease in the acute period or those complications that develop against this background( pneumonia, pyelocystitis, etc.).Often even the symptoms of heart failure are mistaken for complications and are not considered signs of cardiac muscle lesions.
The data of instrumental methods of investigation are the most reliable in the recognition of cardiac damage. Of great importance are additional methods of investigation. With capillaroscopy, spastic and spastic-atonic state of capillaries, unevenness of their blood filling, pericapillary edema, decrease in resistance and increase in permeability, retained for a long time( and after discharge from the hospital) are revealed. At the beginning of the disease on the ECG sharp high teeth P, electric alternative to the R wave, reduction and deformation, sometimes inversion of the T wave, extrasystole are recorded.
In severe forms of influenza, the contractile function of the myocardium( an increase in the systolic index) is violated with rapid normalization during recovery. In a later period, there is a decrease in the voltage of the P and T teeth, depression of the S-T segment, an increase in the Q-T interval and a systolic index, which reflects a decrease in the functional state of the myocardium. These changes slowly increase and slowly disappear.
At a roentgenologic research in a late period of a flu reveal a languid pulse of heart, changes of its configuration and depression of a tonus.
In contrast to rheumatic heart disease, there are no pathological changes in the parameters of the "acute phase" of rheumatic fever.
Flow and outcome of .Influenza lesions of the cardiovascular system proceed in most cases favorably - changes in the heart disappear quickly, the pulse, blood pressure and ECG parameters normalize. For a long time, there may be extrasystole, which for months and years is the only evidence of myocarditis. The outcome of the latter depends mainly on the form of the flu. However, cases of sudden death in the late period of influenza in cases of acute cardiovascular insufficiency and after clinical recovery from influenza with myocarditis symptoms are described.
Treatment of .Assign a strict bed rest until the apparent improvement in the child's well-being with a gradual expansion of the ER after the disappearance of signs of myocardial weakness.
In the acute period, along with viral( ribonuclease and interferon) and pathogenetic therapy, use cardiac glycosides, vitamins, in the severe form of myocarditis - glucocorticosteroid hormones. Use drugs that improve metabolic processes in the heart muscle( potassium orotate or methyluracil, multivitamins, including calcium pangamate, riboxin).
In most cases, under the influence of ongoing therapy, recovery occurs. The remaining individual extrasystoles with good health of the child, the absence of tachycardia and signs of decreased myocardial function are not the reason for the restriction of the regimen.
Increased heart changes after the flu in a child who has had rheumatic heart disease in the past indicates a relapse of the rheumatic process. Even in the absence of obvious signs of such a patient should appoint a short course of antirheumatic therapy.
Women's magazine www. BlackPantera.en: Dmitry Krivcheni