Abstract
Aim . To study the specifics of clinical course and outcomes of higher degree AVB, developed due to inflammatory changes of myocardium in infants, during three years follow-up. Material and methods . For the assessment of AVB specifics in current myocarditis we have summarized the investigation data of 6 patients younger than 1,5 y. o.; mean age 10,0±4,5 months (3 to 16 months). In all clinical cases we performed the analysis of medical source documents with outcopying of pregnancy data, analysis of cardiotocography (CTG) data and ultrasound examination (USE) of the fetus (to rule out inborn cause for AVB), stages of the growth and development of a child, diseases anamnesis. The complex laboratory and instrumental investigation was done, including evaluation of biochemical markers of inflammation and serum markers of myocardial damage, electrocardiographic (ECG) and echocardiographic (EchoCG) studies. Results. Mean follow-up was 23,3±10,4 months (from 9 to 35 months). On treatment, all patients had tendency for the decrease of cardiac specific enzymes, the decrease of heart failure functional class and positive EchoCG dynamics by the end of the first year. However, AV-conduction disorders of the heart in all patients had irreversible course. Permanent pacemaker (PPM) was set up in two cases, in 6 and 14 months after diagnosis. Conclusion. In infants the AV conduction disorders that develop in myocarditis, show irreversible pattern of clinical course.
Highlights
АА — антагонисты альдостерона, АВ — атриовентрикулярный, атриовентрикулярные блокады (АВБ) — атриовентрикулярная блокада, АСТ — аспартатаминотрансфераза, иАПФ — ингибиторы АПФ, конечно-диастолического размера левого желудочка (КДРЛЖ) — конечно-диастолический размер левого желудочка, КТГ — кардиотокография, КФК — креатинфосфокиназа, ЛДГ — лактатдегидрогеназа, ПЦР — полимеразная цепная реакция, постоянного электрокардиостимулятора (ПЭКС) — постоянный электрокардиостимулятор, СН — сердечная недостаточность, УЗИ — ультразвуковое исследование, ЭКС — электрокардиостимулятор, ЭхоКГ — эхокардиография, эхокардиографический
For the assessment of AVB specifics in current myocarditis we have summarized the investigation data of 6 patients younger than 1,5 y. o.; mean age 10,0±4,5 months (3 to 16 months)
In infants the AV conduction disorders that develop in myocarditis, show irreversible pattern of clinical course
Summary
Aim. To study the specifics of clinical course and outcomes of higher degree AVB, developed due to inflammatory changes of myocardium in infants, during three years follow-up. In infants the AV conduction disorders that develop in myocarditis, show irreversible pattern of clinical course. Однако развитие аритмий или изменений на ЭКГ при остром воспалении миокарда является чувствительным индикатором острого миокардита и описано у 90% детей [2]. Большинство авторов описывают благоприятное течение нарушений АВ проведения на фоне острых миокардитов у детей при своевременном лечении основного заболевания, с полным восстановление АВ проведения без необходимости имплантации постоянного электрокардиостимулятора (ПЭКС) в последующем [9]. Патогенез нарушений АВ-проведения на фоне вирусного процесса обусловлен отеком и повреждением клеток проводящей системы сердца, что приводит к нарушению проведения от блокады ножек пучка Гиса до полной АВБ [6, 10].
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