[Ventricular extrasystole as manifestation of viral myocarditis and myopericarditis in young patients].

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.

[Dilated cardiomyopathy resulting from asymptomatic and subclinical myocarditis]. / Dilatatsionnaia kardiomiopatiia kak iskhod bessimptomnykh i subklinicheskikh miokarditov.

The paper presents data on 10 patients with dilated cardiomyopathy (DCM) or chronic myocarditis with fatal outcomes in whom heart failure was preceded by abnormal ECG changes originally regarded as the manifestations of coronary heart disease or small myocardial infarction. The clinical course of the disease and morphological studies suggest that the ECG changes were associated with pre-existing asymptomatic viral myocarditis.

[Long-term outcomes of viral myopericarditis in young patients]. / Otdalennye nabliudeniia pri virusnykh mioperikarditakh u lits molodogo vozrasta.

Long-term follow-up (mean 14.1 +/- 6.6 years) of 54 young patients who have undergone acute viral myopericarditis of mild or moderate severity demonstrates a favourable outcomes in the majority of the examinees in spite of residual fibrous changes in the myocardium registered at ECG. Fibrous pericardial thickening detected in 89.4% patients at echocardiography is proposed as a differential-diagnostic indicator of old myopericarditis.

[Staphylococcal toxic shock syndrome in young women]. / Stafilokokkovyi toksicheskii sindrom u zhenshchin molodogo vozrasta.

A literature review is presented on staphylococcal toxic shock syndrome. A case of this syndrome in a 39-year-old woman is reported. Clinical, pathology, treatment data on this condition are analysed.

[Hypertrophic cardiomyopathy and viral, idiopathic myopericarditis]. / O sviazi gipertroficheskoi kardiomiopatii s virusnymi i idiopaticheskimi mioperikarditami.

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.

[Early ventricular repolarization as a probable consequence of acute viral and idiopathic myopericarditis]. / Ranniaia repoliarizatsiia zheludochkov kak vozmozhnoe posledstvie ostrykh virusnykh i idiopaticheskikh mioperikarditov.

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.

[Functional study of the heart valve apparatus by 2-dimensional Doppler echocardiography in rats with experimental endocarditis caused by Coxsackie B3 viruses]. / Issledovanie funktsional'nogo sostoianiia klapannogo apparata serdtsa metodom dvukhmernoi doppler-ékhokardiografii u krys pri éksperimental'nom éndokardite, vyzvannom virusami Koksaki B3.

Eleven neonatal cotton rats were infected with Coxsackie B3 viruses, 9 animals served as controls. The course of the disease was followed for 44 to 154 days. Electro- and phonocardiography, two-dimensional Doppler echocardiography, morphological and histological studies were performed in the experiment. All the histologically examined infected rats were found to develop myocarditis, whereas 75% of the animals had valvulitis. The total number of the afflicted values was 10, out of them the mitral, tricuspid, and pulmonary trunk valves accounted for 40, 40, and 20%, respectively. Doppler echocardiography revealed organic mitral and tricuspid insufficiencies in the outcome of valvulitis induced by Coxsackie B3 viruses due to the impairment of valvular cusp.

[Physiological valvular regurgitation in healthy persons (its prevalence, hemodynamic characteristics and differential diagnosis)]. / Fiziologicheskaia klapannaia regurgitatsiia u zdorovykh liudei (rasprostranennost', gemodinamicheskaia kharakteristika, differentsial'nyi diagnoz).

Two-dimensional Doppler echocardiography (DECG) was employed to examine for valvular regurgitation 100 healthy subjects. Physiological valvular regurgitation (PVR) was detected in 32 of them. It was defined as isolated pulmonary, isolated tricuspid, combined tricuspid and pulmonary, mitral in 17%, 9%, 4% and 2% of the examinees, respectively. Hemodynamically, PVR was characterized by low maximal speed of the flow and minimal extension. It should be noted that similar hemodynamic DECG parameters can be registered in minimal aphonic valvular regurgitation arising in latent rheumatic and viral endocarditides. This fact must be taken into consideration when making the differential diagnosis.

[Abramov's "primary myocarditis", Fiedler's myocarditis and dilated cardiomyopathy]. / O "pervichnom miokardite" Abramova, miokardite Fidlera i dilatatsionnoi kardiomiopatii.

After comparing the clinical and post mortem signs of myocarditis and dilated cardiomyopathy on the basis of correlating the reported data and own data on 28 patients with the appropriate descriptions by S. S. Abramov and A. Fiedler, the authors came to the conclusion that they had described two different diseases. S. S. Abramov had described dilated cardiomyopathy, whereas Fiedler acute diffuse myocarditis. The term Abramov-Fiedler myocarditis used in the Soviet literature does not correspond to the up-to-date classification of myocardial diseases. That is why it is required that these two concepts be separated to the benefit of the treatment.

[The role of Coxsackie B viruses in the etiology of dilated cardiomyopathy]. / O roli virusov Koksaki gruppy B v étiologii dilatatsionnoi kardiomiopatii.

In order to establish the relationship between Coxsackie B virus infection and dilated cardiomyopathy (DCMP), 53 patients suffering from DCMP underwent serological tests. The rate of demonstration of virus-neutralizing antibodies at different titres was compared with the respective values in the previously examined 180 patients with myocarditis, 58 patients with myocardial sclerosis and 150 normal persons. In DCMP, antibodies against B2 type virus were detectable more frequently (p less than 0.001) and at higher titres (p less than 0.05) that in normal persons. Antibodies at the titres greater than 1:128 were most demonstrable in myocarditis and then at an equal rate in DCMP and focal myocardial sclerosis following Coxsackie myocarditis. The conclusion is drawn about the relationship between Coxsackie infection and DCMP as well as between DCMP and myocarditis. The reported data on the mechanisms by which myocarditis progresses to DCMP are discussed.

[Viral myocarditis (the etiologic, clinical, diagnostic and treatment problems)]. / Virusnye miokardity (voprosy étiologii, kliniki, diagnostiki i lecheniia).

To elucidate the etiology of respiratory infection and pharyngitis associated myocarditis a serological study was made of 201 patients who were successively admitted with a clinical diagnosis of myocarditis. Coxsackie viral infection of group B, influenza A and B, para-influenza and adenoviral infection and beta-hemolytical streptococcus of group A were determined. Preceding Coxsackie infection was established in 38,3% of the patients, influenza A and B in 27.5%, adenoviral infection in 3.6% and para-influenza in 1.7%. beta-hemolytical streptococcus as the cause of myocarditis was detected in 4.9% of the patients only. In view of the viral etiology of most cases of myocarditis the authors discussed the problems of its pathogenesis, clinical course and therapy.