Search

The paper presents a practical case of histiocytoid cardiomyopathy concurrent with noncompact myocardium, atrial septal defects, myocarditis, and pericarditis in an 8-month-old girl, by describing their clinical presentations and a morphological examination.

Aim: To investigate relationship between frequent and complicated ventricular extrasystole (VE) in young patients and previous viral myocarditis (VM); to study VE long-term prognosis., Material and Methods: We examined 75 patients with mild and moderate myocarditis which developed after acute respiratory infections and other viral diseases (Coxsackie infection was serologically confirmed in 49%; flu, paraflu and adenoviral infection--in 8%). Acute myocarditis was diagnosed basing on the data of ECG, activity of cardiospecific enzymes and isoenzymes, x-ray, echocardiography, Holter ECG monitoring, exercise tests. The patients were followed up from 3 to 26 years (mean 14.6 years)., Results: Bigeminal polymorphic extrasystoles and bigemia sites persisted for the whole periods of observation. They could disappear at resting ECG but were registered at 24-h ECG monitoring in all the cases. Echocardiography detected fibrous alterations of the pericardium with its thickening in 89% cases. Exercise tolerance test at the end of the study recorded normal physical performance in 89.3% patients. This suggests a favorable disease outcome. Low physical performance, moderate dilation of the left ventricle and ejection fraction lowering to 48% requiring medication were observed only in 4 patients who were capable to work., Conclusion: Frequent and complicated VE after viral myocarditis were present at resting ECG for many years in 42.3% patients. Holter 24-h ECG monitoring registered VE in all the examinees. 89% patients had fibrous lesions of the pericardium showing that viral myocarditis in most cases runs as myopericarditis, in some cases being subclinical.

Among 64 patients followed up for 3 to 24 years after acute viral or idiopathic myopericarditis 10 patients were found to have hypertrophic cardiomyopathy. At echo-CG they had asymmetric hypertrophy of the septum. Manifestations of acute myopericarditis, results of laboratory and functional investigations are presented. Hypertrophic cardiomyopathy runs asymptomatically or with few symptoms. The relations between cardiomyopathy and viral infection are discussed.

64 patients who had acute viral or idiopathic myopericarditis (40 males and 24 females aged 16-48 years) were followed up for 3 to 24 years. Echocardiography has found thickening of the pericardium from 5 to 8 mm which corresponded to fibrosis in 55 patients (85.9%). Early repolarization was detected in 17 patients, in 14 of them it was associated with pericardial thickening (82.4%). Of 30 healthy controls, early repolarization in combination with pericardial fibrosis occurred in 6.7% of cases. In 7 patients with early repolarization ECG registered residual changes of the acute period, in 6 new changes arose--His block and left ventricular hypertrophy. It is suggested that in many cases early repolarization is not independent, it is sequelae of previous myopericarditis.

On the basis of ECG recorded in 35 precordial leads and subsequent cartographic analysis of the results obtained, the state of the necrotic and periinfarction zones in 38 patients with complicated myocardial infarction (development of circulatory insufficiency, acute aneurysm of the left ventricle, and pericarditis epistenocardica) was analysed. In circulatory insufficiency being the only complication, significantly smaller values of the indices characterizing the necrotic and periinfarction zones were found. In pericarditis, dynamics of the most mobile ECG indices was observed which characterized the state of the periinfarction zone in the direction of diminution (by half) by the end of the 1st week; in aneurysm the same degree of diminution was noted only by the end of the 2nd week of the process. In fatal outcomes of the disease these indices fluctuated within the range of the individual levels of the initial values without showing any obvious tendency to decrease in the first 2 weeks of the disease.

Alternation of the heart was revealed in 18 of 74 patients with tumorous pericarditis with effusion (24%). It was found most frequently in patients with a drastically enlarged heart and a large amount of exudate in the pericardial cavity. An electrical, mechanical and mixed character of alternation was encountered in pericarditis with effusion. Electrical alternation was caused by increased mobility of the heart in the fluid, mechanical alternation (pulsus alternans) was caused by diminished contractile function of the myocardium. In certain cases alternation of the heart is a reversible process and may disappear under the effect of treatment including irradiation, chemotherapy and pericardiocentesis.

In using the method of dye dilution improved by reflectometry by means of fibrooptic catheters the authors measured the volumes of the right ventricle in patients with hemodynamics close to normal, in patients with a tension load of the right ventricle, with a volumetric load, in decompensation and in pericarditis. The authors noted a constancy of the relative stroke volume in compensated work of the right ventricle (approximately 53%). They regard this index to be the criterion of normal pump function of the right ventricle. In deficiency of this function the relative stroke volume may be reduced by nearly half, to 28%.

56 heart specimens with pericarditis of different etiology were studied (uraemic, tuberculous, bacterial). In the majority of cases pericarditis was a complication of rheumatic heart diseases, fibrous-cavernous tuberculosis and chronic nonspecific pulmonary lesions, cardiac tumours and other pathology. Models of uraemic and purulent pericarditis were created in 5 rabbits and 30 dogs. The methods of venous injections and cardiac blood vessels injections, angioradiography, macro- and microscopy, histology, electrocardiography were employed. The function of the lymphatic system of the heart was determined by studying dynamically the resorption of Polyglukin from the pericardial cavity of the experimental animals. It was established that the disorders in cardiac activity in cases of pericarditis largely depend on the involvement of its vessels, primarily of the cardiac microcirculation bed, as well as of the veins and lymph vessels ensuring the drainage of the myocardium. Blocks of the venous and lymphatic beds of the epicardium in acute bacterial pericarditis causes disorders in blood and lymph circulation in the superficial layers of the heart muscle. Oedema and hypoxia developing in such situations favour the transit of the process into a chronic one with the formation of adhesions of the serous sheaths of the heart. The complication of any disease by bacterial pericarditis, especially with the development of pericardial obliteration, should be considered as an unfavourable factor worsening the prognosis. Aseptic pericarditis is accompanied by insignificant changes in the vascular system of the heart and cause important disorders in the blood and lymph circulation only in cases of constrictive pericarditis formation.

The method of integral rheography was used for the examination of 126 patients with different forms of pericarditis. The authors have established different nature of the blood circulation insufficiency (heart compression and myocardiodystrophy), which should be taken into consideration in choosing the methods of treatment.