CORONARITISIS [coronaritis; lat. (arteria) of coronaria a coronal artery + - itis] — an inflammation of walls of coronal arteries of heart.
To. meets at many diseases, but the frequency of its identification in clinic is small and usually it is distinguished only at a pathoanatomical research.
To. can arise at an exacerbation of rheumatism and during various acute inf. diseases (sypny and typhoid, paratyphus, malaria, scarlet fever, flu, etc.); at the same time inflammatory process proceeds sharply, affects both large, and small coronal arteries and is extremely seldom shown clinically. Acute abacterial To. it is observed at poisonings with corrosive sublimate and arsenic, and also at radiation injuries. It is possible also allergic To., including at a medicamentous allergy. Reason subacute and hron. To. can be syphilis (see), brucellosis (see), and also rheumatism (see) and other general diseases of connecting fabric, especially periarteritis nodular (see), a system vasculitis like Thrombangiitis obliterans (see. Thromboangitis obliterating ). Cases are described To. at subacute septic endocarditis (see), temporal arteritis (see. Arteritis giant-cell ), a panarteritis of an aorta and its branches (see. Takayasu syndrome ), an acute isolated myocarditis of Abramov — Fidlera (see. Myocarditis ) and hard proceeding infectious and allergic myocardites, and also at some primary not subaortic stenosis, in particular at an idiopathic hypertrophy of a myocardium (see. Cardiomyopathy ). Rarely the reason To. tuberculosis is.
Inflammatory process at To. it can preferential be localized in one of layers of an arterial wall (a periarteritis, a mesarteritis, an endarteritis), but simultaneous defeat of all its layers is most often observed (panarteritis). Patol, anatomy of a vascular wall is defined by the changes characteristic of a basic disease. Cases isolated To. meet exclusively seldom.
Clinical picture it is characterized by manifestations coronary insufficiency (see), including. stenocardia (see), myocardial infarction (see). At patients with a subacute septic endocarditis, a nodular periarteritis, acute isolated myocarditis of Abramov — Fidlera and primary cardiomyopathies To. quite often proceeds malosimptomno and it is distinguished only on focal changes of a myocardium which come to light elektrokardiografichesk. Much more often explicit symptoms of coronary insufficiency develop at patients syphilitic To., and also at To., proceeding against the background of an acute isolated myocarditis, an idiopathic hypertrophy of a myocardium and Takayasu's disease. At syphilitic To. stenocardia proceeds hard and is extremely tolerant to treatment; quite often the macrofocal myocardial infarction develops. Sometimes syphilitic To. establish only during autopsy at persons, the dead suddenly. Data on symptoms of coronary insufficiency at the most widespread rheumatic To. are contradictory. Only isolated reliable cases of a myocardial infarction at this form K are described.
the Diagnosis is, as a rule, very difficult since it the most frequent reason of stenocardia and myocardial infarction is coronary heart disease (see). About an opportunity To. it is necessary to think at development of coronary insufficiency in patients with the diagnosed syphilis, rheumatism, an obliterating thromboangitis or other diseases at which inflammatory damage of coronal arteries of heart meets. In all cases of stenocardia and myocardial infarction (especially at patients of young and middle age) the careful research directed to identification or an exception of diseases which can be the cause To is necessary. The same situation belongs also to clinically asymptomatic focal damages of a myocardium revealed elektrokardiografichesk. If To. there are the leading or only display of a disease, a maloinformativna even data of the selection coronary angiography (see), since rentgenol, a picture at the most widespread damage of coronal arteries of heart — atherosclerosis — extremely a polimorfna. To suspect syphilitic To. existence of simultaneous defeat of proximal departments of both main coronary arteries at their high otkhozhdeniye from an aorta allows.
Treatment matches therapy of a basic disease, edge in the presence To. it is carried out especially intensively and in most cases includes use of glucocorticoids. At the expressed coronary insufficiency individually select anti-anginal drugs and appoint antihypoxemic means, analgetics.
The forecast and Prevention
the Forecast is defined by expressiveness of coronary insufficiency and the forecast of a basic disease.
Prevention comes down to timely and adequate treatment of syphilis, rheumatism and other infectious and infektsionnoallergichesky diseases which can become the reason To.
V. A. Bogoslovsky