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PUBLISHED DATE: - 19-11-2024
https://doi.org/10.37547/tajas/Volume06Issue11-03
PAGE NO.: - 13-16
MAIN SYMPTOMS OF NON-RHEUMATIC
MYOCARDITIS IN OLDER CHILDREN
ACCORDING TO ECG
Marhabo Miyassarovna Qodirova
Assistant at the Department of Propaedeutics of Childhood Diseases at
Samarkand State Medical Institute, Uzbekistan
Shaxboz Rahimjonovich Najimov
Assistant at the Department of Propaedeutics of Childhood Diseases at
Samarkand State Medical Institute, Uzbekistan
INTRODUCTION
Non-rheumatic myocarditis is an inflammatory
heart disease caused by various etiologies,
unrelated to rheumatism or other systemic
diseases. According to the WHO classification,
myocarditis is a specific disease of the heart muscle
RESEARCH ARTICLE
Open Access
Abstract
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with identified causes, involving inflammatory
infiltration, fibrosis, necrosis, or degeneration of
cardiomyocytes. Diagnosing myocarditis is
challenging for practitioners due to difficulties in
differentiating it from other inflammatory
conditions of the heart.
The clinical and pathological features of non-
rheumatic myocarditis often overlap with those of
dilated cardiomyopathy, making it hard to
distinguish between the two. Many cases of
myocarditis can lead to dilated cardiomyopathy,
characterized by the development of myocardial
fibrosis as inflammation subsides. This highlights
the
importance
of
studying
myocarditis
comprehensively. In children, inflammatory
processes may involve not only the myocardium
but also the pericardium and endocardium,
prompting N.A. Belokon to propose the use of the
term “carditis.”
Relevance of the Issue:
Myocarditis can occur at any age, with higher
prevalence among young children. In some cases,
mild forms of myocarditis may remain
asymptomatic and unrecorded, complicating
efforts to determine its true prevalence (N.V.
Orlova, T.V. Pariyskaya, 2019). According to
studies, 24-33% of children may have
asymptomatic myocarditis (E. Rarillo, 2018). Yu.M.
Belozerov’s research found that myocarditis affects
10 out of every 1,000 people (Belozerov, 2014),
with myocardial damage occurring in 1-5% of
patients with acute viral infections (Belozerov,
2014).
Mild forms of myocarditis are asymptomatic, while
severe forms can cause complex cardiac rhythm
disturbances, heart failure, and acute circulatory
disorders (E.N. Amosova, 2018; V.S. Prikhodka,
2011). In children, the clinical presentation of
myocarditis is often nonspecific, posing a
diagnostic challenge for practitioners. Modern
studies have detected anti-cardiac antibodies in the
blood serum of children with myocarditis (V.P.
Krivonostov, 2016).
The clinical manifestations of myocarditis in
children vary depending on its etiology, extent, and
severity. Mild cases are often asymptomatic, but
severe cases can involve complex arrhythmias,
heart failure, and acute circulatory disorders (E.N.
Amosova, 2012; V.S. Prikhodka et al., 2013). Thus,
one of the urgent tasks in pediatric cardiology is to
investigate the specific clinical features and
prevalence of non-rheumatic myocarditis in
children of different ages in Samarkand.
Research Object and Subject:
We conducted clinical and electrocardiographic
analyses of 50 young children with non-rheumatic
myocarditis treated at the Cardio-Rheumatology
Department
of
the
Samarkand
Regional
Multidisciplinary Children’s Clinical Center
between 2018 and 2019.
Research Objective:
To study the current clinical picture and ECG
symptoms of non-rheumatic myocarditis in young
children and to compare the findings with data
from the literature.
Research Tasks:
1.
To investigate the current clinical course and
diagnostic criteria of non-rheumatic myocarditis in
young children.
2.
To study ECG changes specific to non-
rheumatic myocarditis in young children.
3.
To conduct a comparative analysis of the
study findings with data from the literature.
RESULTS
Our study revealed that 86% of young children
with non-rheumatic myocarditis had a history of
acute respiratory infections. Perinatal history
showed that 82% had anemia and 46% had
gestational complications. In children with non-
rheumatic myocarditis, 92% developed the
condition against a background of anemia, while
36% had exudative-catarrhal diathesis or
hypotrophy, and 30% had lymphatic-hypoplastic
diathesis. The clinical symptoms included general
weakness (88%), excessive sweating (86%), cough
(50%), cyanosis around the lips and nose (58%),
and pale, marble-like skin (76%). Muffled heart
sounds were present in all patients, with a “gallop”
rhythm observed in 32% of cases. Tachycardia was
noted in 80% of cases, arrhythmia in 14%,
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extrasystole in 14%, and bradycardia in 4%.
ECG Findings:
•
Rhythm disorders: Sinus tachycardia (88%),
sinus arrhythmia (12%), extrasystole (14%), and
sinus bradycardia (6%).
•
Conduction disorders: Interventricular
conduction disorder (24%), contraction phase
disturbance (66%), incomplete right bundle
branch block (24%).
Right ventricular hypertrophy was observed in
24% of cases, left ventricular hypertrophy in 46%,
and cardiomegaly in 20%.
The S-T segment represents the distance between
the end of the QRS complex and the beginning of
the T wave. In healthy children, the S-T segment
may deviate 0.5-1 mm above or below the
isoelectric line. According to our findings:
•
In children under 3 years old, the S-T
segment was elevated by 2.5 mm in leads V2 and
V3 in 8 children, and by 3 mm in leads V3 and V4 in
7 children.
•
In children aged 3-7 years, no changes in the
S-T segment were observed.
•
In children aged 7-12 years, the S-T segment
was elevated by 2.5 mm in leads III and V1 in 2
children, and by 4 mm in leads I, aVL, and V5 in 3
children,
indicating
subendocardial
and
subepicardial ischemia.
Table 3.7: ECG Parameters in Children Aged 7 to 12
Years
The table presents the millimeter measurements of
ECG waves and the duration of intervals in seconds
for children aged 7 to 12 years.
Increase in R-wave amplitude: An increase in R-
wave amplitude above 7 mm was observed in 14%
of patients aged 7-12 years in leads I, aVL, and V5,
V6. This finding indicates left ventricular
Waves
Lead
I
II
III
V
1
V
5
Р
Min
0,2
0
-1,0
0,4
0,4
Maх
1,4
2,6
1,4
2,4
2,0
Medium
1,1
0,9
Х0,6 1,2
1,5
Q
Min
0
0
0
0
0
Maх
3,6
3,0
5.0
0
5,4
Medium
0.76 0,56
1,39
0
0,46
R
Min
3,0
3,0
1,0
1,0
5,0
Maх
14.0 19,0
18,0
15,0
20,0
Medium
7,6
10,7
6,5
5,6
12,6
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hypertrophy (LVH).
2.
R-wave enlargement in specific leads:
Enlargement of the R-wave in leads III, aVF, V1, and
V2 suggests hypertrophy of the right ventricle
(RVH). RVH was identified in 28% of children
under 3 years of age (9 patients).
3.
S-T segment elevation: According to our
findings, 8 children under 3 years old exhibited an
S-T segment elevation of 2.5 mm above the
isoelectric line in the chest leads V2 and V3.
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