Diagnosis

Diagnosis of acute rheumatic myocarditis

In general a diagnosis is easily assigned, but this may be more challenging in cases where the joints (articulations) are not affected (abarticular forms).

Clinical tests and results

Clinical results, a thorough history of the condition aid in determining a diagnosis. Tachycardia and a general expansion of the heart outline are visible from the very beginning when first consulting with a physician.

During auscultation (using a stethoscope to listen to the heart sounds), the heart sounds are low, sounding like they are coming from far away especially at the apex of the heart, due to a lowering in contractile capacity of the myocardium. When the heart has expanded far too much and its muscles have lost their tonus, a galloping presystolic rhythm is heard.

The electrocardiogram

The electrocardiogram is an examination which aids in diagnosis. It is facilitated by a machine which ;has electrodes. These electrodes are places on the chest, wrists and ankles. This machine allows doctors to view the electric activity of the heart and it reveals any rhythm problems, such as tachycardia, fibrillation, etc, as well as problems in circulation, such as atriventricular blocks, etc.

For this condition, a physician will notice the following: an elongation of the P-Q interval, low voltage, a sub-level, bow-shaped deformed S-T interval, and the T spike will be flat or negative.

The echocardiogram

An echocardiogram is an ultrasound examination which utilizes a probe which is used on the chest, or a trans esophageal echo where the proble is attached to a light source and sent through the esophagus in order to view the heart via a monitor.

This examination will show whether there is an enlargement of the heart, or whether inflammation has caused a thickening of the myocardium walls.

Blood tests

Blood tests play an important role in establishing a diagnosis.

They will exhibit the following characteristics: 

1. Leukocytosis 

2. An elevated sediment 

3. Elevated titer of antistreptolysins  

4. A deviation of the leukocyte formula to the left 

5. Elevated fibrinogen 

6. Elevated alfa2 globulins 

7. Elevated mucoproteins, glucoproteins, syalic acid, etc.

Conditions against which to run a differential diagnosis

1. Acute rheumatic endocarditis; the examination which is commonly used to differentiate is the electrocardiogram, the changes in the myocardium differ too wildly and are too specific. 
2. Acute rheumatic pericarditis; friction in the pericardium is audible for this condition, these changes would be visible in the echo as well as the ECG. 
3. Myocarditis occurring at the same time as acute infectious diseases; such diseases include diphtheria, typhus of the intestines or exanthematous typhus, the flu, etc. The differentiation can be made by examining epidemiological, clinical, bacteriological, virological or serological data, which all aid in determining diagnosis.  

Prognosis

Prognosis is usually highly reserved. In a majority of cases, the disease can be healed, and if the diagnosis is determined early, treatment is immediately initiated. There is, however, a significant risk that the disease may become chronic, or become involved with rhythm disruptions and cardiac insufficiency. All of the above may hinder the condition of the patient and lead to an unfavorable, reserved prognosis.  

Prophylaxia

It is very important to treat the disease as quickly as possible, immediate initiation of therapy holds cardinal important in order to prevent heart damage. It is important to also note that the treatment of this disease must persist even after the symptoms are gone and the patient feels better. After the rheumatic attack subsides, prophylactic treatment must be initiated, because the disease may repeat itself.  

It is recommended to treat with antibiotics for a long time. Following the healing of the disease, antibiotic injections should be performed every 2-3 weeks over several months.
Following this the injections are performed once a month. Prophylactic medication must be followed for the 2-3 years following this disease without interruption. Following the subsequent 2-3 years, prophylactic treatment is usually only conducted during October-March.