JOURNAL OF HEPATO-GASTROENTEROLOGY RESEARCH | ЖУРНАЛ ГЕПАТО-ГАСТРОЭНТЕРОЛОГИЧЕСКИХ ИССЛЕДОВАНИЙ
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Shavazi Nurali Mamedovich,
Doctor of Medical Sciences, Professor, Head of
the Department of 1 Pediatrics and Neonatology
Samarkand State Medical Institute,
Samarkand, Uzbekistan
Kardjavova Gulnoza Abilkasimovna,
assistant of the Department of 1 Pediatrics and Neonatology
Samarkand State Medical Institute,
Samarkand, Uzbekistan
Lim Maksim Vyacheslavovich,
PhD., Associate Professor of
the Department of 1 Pediatrics and Neonatology
Samarkand State Medical Institute,
Samarkand, Uzbekistan
Ibragimova Marina Fyodorovna,
assistant of the Department of 1 Pediatrics and Neonatology
Samarkand State Medical Institute,
Samarkand, Uzbekistan
FEATURES OF THE CURRENT OF ACUTE MYOCARDITIS IN CHILDREN ON THE BACKGROUND OF
COMMUNITY-ACQUIRED PNEUMONIA
ANNOTATION
Pneumonia in children is one of the urgent problems in pediatrics, which is determined by the continuing high
incidence and severe prognosis, especially in young children. The aim of the study was to determine the clinical
characteristics of acute myocarditis in children with community-acquired pneumonia. We examined 46 children aged 6
months to 7 years with pneumonia, which we divided into 2 groups. Group I (control) included 23 children who had
only respiratory complaints. Group II (main) included 23 sick children with pneumonia, who had a violation of the
cardiovascular system, the presence of which was confirmed by instrumental methods. The results obtained emphasize
that against the background of community-acquired pneumonia, all symptoms of acute heart failure are masked, the
cause of which in most cases is acute coronary insufficiency; changes in the heart muscle in this pathology in children
increases the risk of severe unwanted heart complications.
Key words:
acute myocarditis, community-acquired pneumonia, children
Шавази Нурали Мамедович,
д.м.н., профессор, заведующий кафедрой педиатрии №1 и неонатологии
Самаркандский Государственный медицинский институт.
Узбекистан.
Карджавова Гульноза Абилкасимовна
,
ассистент кафедры педиатрии №1 и неонатологии,
Самаркандский государственный медицинский институт,
Узбекистан
Лим Максим Вячеславович,
доцент кафедры педиатрии № 1 и неонатологии
Самаркандский Государственный медицинский институт.
Узбекистан.
Ибрагимова Марина Фёдоровна,
ассистент кафедры педиатрии № 1 и неонатологии
Самаркандский Государственный медицинский институт.
Узбекистан.
JOURNAL OF HEPATO-GASTROENTEROLOGY RESEARCH | ЖУРНАЛ ГЕПАТО-ГАСТРОЭНТЕРОЛОГИЧЕСКИХ ИССЛЕДОВАНИЙ
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ОСОБЕННОСТИ ТЕЧЕНИЯ ОСТРОГО МИОКАРДИТА У ДЕТЕЙ НА ФОНЕ ВНЕБОЛЬНИЧНОЙ
ПНЕВМОНИ
АННОТАЦИЯ
Пневмония у детей - одна из актуальных проблем педиатрии, что определяется сохраняющейся высокой
заболеваемостью и тяжелым прогнозом, особенно у детей раннего возраста. Целью исследования явилась
определить клиническую характеристику острого миокардита у детей на фоне внебольничной пневмони. Было
обследовано 46 детей в возрасте от 6 месяцев до 7 лет с пневмонией, которых мы разделили на 2 группы. В I
группу (контрольную) включили 23 детей, которые были только с респираторными жалобами. Во II группу
(основную) вошло 23 больных детей с пневмонией, имевшие нарушение со стороны сердечно-сосудистой
системы, наличие которых был подтверждены инструментальными методами. Полученные результаты
подчеркивают, что на фоне внебольничной пневмонии маскируется все симптомы острой сердечной
недостаточности, причиной которого в большинстве случаев является острая коронарная недостаточность,
изменение сердечной мышцы при этой патологии у детей повышает риск возникновения тяжелых
нежелательных осложнений со стороны сердца.
Ключевые слова
: острый миокардит, внебольничная пневмония, дети
Relevance
.
For
several
decades,
severe
pneumonia has remained one of the urgent problems of
modern medicine due to the steady trend towards an
increase in the number of patients and a consistently high
mortality rate, despite the use of new principles and
methods of treatment [3,4]. The probable reason for this
is the delayed diagnosis and, as a consequence, late
initiation of treatment, as well as the impossibility of
conducting an adequate assessment of the effectiveness of
therapy. The diagnosis of pneumonia in children is often
difficult, especially if signs of respiratory failure have
developed against the background of ARVI. The problem
of acute myocarditis is currently due to its widespread
occurrence, especially in childhood.
One of the main causes of acute myocarditis
today is acute respiratory viral infections (ARVI), which
remain the most common and global diseases in children.
Cardiovascular failure is common in pneumonia,
especially in young children. It develops rapidly, already
in the early stages of the disease. With an uncomplicated
course of the disease, clinically latent heart failure occurs,
it is diagnosed with the help of instrumental studies such
as ECG, Echo CG. With community-acquired pneumonia
in children, dysfunction of the cardiovascular system can
clinically manifest itself in the form of coronary
insufficiency, and more often cardiovascular failure.
[2,7.9,]. Each flu epidemic accompanied with a
complication of pneumonia in children is associated with
an increase in the number of cases of acute myocarditis,
which determines the urgency of studying this problem.
An even more serious task is the timely
diagnosis of complications of pneumonia, especially
myocarditis, since the identification of this cardiac
complication allows you to avoid severe and sometimes
fatal consequences for the patient. Previously developed
clinical criteria, diagnostic criteria for the diagnosis of
heart failure are not always objective enough to identify
circulatory disorders in young children. For example,
anxiety, decreased appetite, poor sleep in children are
almost always noted. Tachypnea and tachycardia can be
not only a sign of pneumonia, but also occur in a healthy
child during examination, feeding, etc. Shortness of
breath, tachypnea are always accompanied by diseases of
the bronchi and lungs. The frequency of myocarditis in
pneumonia according to different authors varies from 1 to
15%. From a diagnostic point of view, there are no
specific electrocardiographic changes characteristic only
for myocarditis.
Myocarditis is an inflammatory lesion of the
heart muscle of an infectious, toxic-infectious, infectious-
allergic, autoimmune and toxic etiology [6]. This disease
is predominantly of children and young people, although
the disease can develop at any age. Any viral or bacterial
agents, as well as non-infectious factors, can be the cause
of myocarditis. The most common cause of the disease is
viruses. In 6-8% of cases, myocarditis develops during or
shortly after various sporadic or epidemic viral infections
[1].
Of the bacterial myocarditis, the most dangerous
are diphtheria (infectious toxic), myocarditis with scarlet
fever, typhoid fever and salmonellosis, tuberculosis,
yersiniosis (intestinal and pseudotuberculosis), with
generalized streptococcal and staphylococcal infections,
10 pathogens associated with these [8]
Purpose.
To
determine
the
clinical
characteristics of acute myocarditis in children with
community-acquired pneumonia.
Materials and research methods.
We examined
children aged 6 months to 7 years with community-
acquired pneumonia, who were hospitalized in the
emergency pediatrics and children's intensive care units
of the SB of RSCEMA. The average age of the examined
children was 2.5. The exclusion criteria were: a previous
infectious disease within a month before hospitalization,
the presence of organic heart disease (congenital and
acquired heart defects, cardiomyopathy), the presence of
signs of rheumatic fever and coronary artery disease. A
total of 46 patients with community-acquired pneumonia
who met the exclusion criteria were included in the study.
The patients were randomly divided into 2
groups Group I (control) included 23 children who had
only respiratory complaints. Group II (main) included 23
sick children with pneumonia, who had a violation of the
cardiovascular system.
Evaluation of the effectiveness of the therapy for
pneumonia according to the standard was carried out on
the basis of objective signs of cyanosis, congestive
wheezing in the lungs and tachycardia. Assessment of the
severity of cyanosis in patients was assessed by central
and peripheral distribution, and cough by a 4-point
system: 0 points - no cough, 1 point - a single cough, 2
points - moderately expressed cough and 3 points -
frequent, painful cough. Tachycardia and cyanosis were
the main signs of heart damage in pneumonia, which
tended to continue even against the background of the
disappearance of intoxication from the underlying
JOURNAL OF HEPATO-GASTROENTEROLOGY RESEARCH | ЖУРНАЛ ГЕПАТО-ГАСТРОЭНТЕРОЛОГИЧЕСКИХ ИССЛЕДОВАНИЙ
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disease.
Additional criteria for the effectiveness of
therapy were the duration of oxygen therapy and the
duration of hospitalization. Patient management was
carried out in accordance with the specifics of the
Emergency Medical Service, diagnostic and treatment
standards (the recommended deadlines for inpatient
treatment of bronchopulmonary diseases were observed).
Discharge criteria were: satisfactory condition, SpO2
≥95%, reduction in cough, shortness of breath and
tachycardia.
The
presence
of
changes
in
the
electrocardiographic
study
of
"metabolic
nature"
according to the conclusion of the cardiologist and
insignificant preserved oral cyanosis were not a
contraindication for discharge. The observation of the
patients continued until the main symptoms of the disease
were completely resolved.
Research results and discussion.
After the
study, the main indicators of patients in the compared
groups were analyzed and compared at admission to the
hospital. The analysis showed that the patients selected
for the main and control groups were comparable in
terms of gender, age, target indicators. Upon repeated
examination of children with cardiac disorders at
discharge, the following hemodynamic parameters
remained: LVEF in the treatment group decreased 45.6 ±
9.6% to 26 ± 6.7% to in the placebo group, where there
was a decrease in EF from 27.7 ± 5.6% to 21.3 ± 5.3%;
of course, the diastolic volume in the treatment group
decreased from 25.7 ± 50.1 to 140.7 ± 50.6 vs in the
placebo group, where EDV increased from 245 ± 46.3 to
280.6 ± 48.9. The most frequent changes recorded on the
ECG are sinus. tachycardia, which was noted in
18(39.1%) patients, ST segment changes in 12, AV block
in 4(8,7%), left bundle branch block in 22(47,8%)
patients. Thus, the most valuable electrocardiographic
parameter in patients with myocarditis , is a change in the
QRS complex.
The results of our study show that it is necessary
to
conduct
echo
cardiographic,
as
well
as
electrocardiographic studies of children with pneumonia,
causes a decrease in complicated cardiorespiratory
syndromes and post hypoxic changes in the ventricular
myocardium, which allows us to conclude that there is a
certain advantage of preventive examination to prevent
the development of chronic cardiovascular pathology.
The most frequent changes recorded on the ECG were
sinus tachycardia, which was noted in 18 (39.1%)
patients, ST segment changes in 12, AV block in 4
(8.7%), left bundle branch block in 22 (47 , 8%) patients.
Studies have shown that at present, the criteria
for early detection of cardiac pathology in patients with
community-acquired
pneumonia
have
not
been
sufficiently developed. Due to the fact that the number of
cardiac pathology at autopsy significantly exceeds its
lifetime detection, the problem of early diagnosis of
cardiovascular pathology and risk factors for its
development in sick children with community-acquired
pneumonia remains an urgent issue of clinical medicine
[4].
Among the pulmonary and extrapulmonary
complications of community-acquired pneumonia, an
important place is occupied by lesions of the
cardiovascular system [2,4]. According to many authors
[1,10], dysfunction of the cardiovascular system is an
almost constant companion of community-acquired
pneumonia and develops from the first hours; at the same
time, circulatory disorders often determine the prognosis
and outcome of pneumonia itself.
Conclusion.
Thus, the clinical manifestations of
heart failure in early childhood are non-specific, which in
order to clarify the diagnosis, it is necessary to conduct a
complete clinical and instrumental study, including an
ECG with the calculation of indicators of central
hemodynamics. An echocardiographic study of children
with pneumonia leads to a decrease in complicated
cardiorespiratory syndromes and post-hypocal changes in
the ventricular myocardium, which allows us to conclude
that there is a certain advantage of preventive
examination to prevent the development of chronic
cardiovascular
pathology
under
the
"mask"
of
community-acquired pneumonia in children and further
transformation of the disease into various cardiopathy.
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