Myocarditis (peds) - Revision history

Ostermayer at 17:43, 17 January 2026

2026-01-17T17:43:12Z

← Older revision		Revision as of 17:43, 17 January 2026
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	{{~~Peds top~~}} ~~[[myocarditis]]~~		{{PediatricPage\|myocarditis}}
	==Background==		==Background==
	*Rare but potentially fatal		*Rare but potentially fatal

Blsimpso: /* External Links */

2021-07-02T02:48:22Z

External Links

← Older revision		Revision as of 02:48, 2 July 2021
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	==External Links==		==External Links==
	*https://pedemmorsels.com/myocarditis/		*https://pedemmorsels.com/myocarditis/
			*[https://emergencymedicinecases.com/pediatric-respiratory-failure/ EMCases - Pediatric Myocarditis]

	==References==		==References==

Cdichang: /* Management */

2020-05-16T04:22:25Z

Management

← Older revision		Revision as of 04:22, 16 May 2020
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	==Management==		==Management==
	*Management tailored to severity of disease		*Management tailored to severity of disease
	*Maintain euvolemia, [[~~diuretics~~]] as needed		*Maintain euvolemia, consider [[furosemide]] as needed
	*If cardiac function significantly depressed, consider [[epinephrine]] or [[dopamine]]		*If cardiac function significantly depressed, consider [[epinephrine]] or [[dopamine]]
	*Consider afterload reduction with [[nitroprusside]] if normotensive		*Consider afterload reduction with [[nitroprusside]] if normotensive

Cdichang: /* Background */

2020-05-16T01:31:37Z

Background

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	==Background==		==Background==
	*Rare but potentially fatal		*Rare but potentially fatal
	*Most common cause of heart failure in previously healthy children, also one of the etiologies for unexpected sudden cardiac death		*Most common cause of heart failure in previously healthy children, also one of the etiologies for unexpected sudden cardiac death in infants
	*Inflammation of myocardium		*Inflammation of myocardium
	**Can lead to dilated [[cardiomyopathy]]		**Can lead to dilated [[cardiomyopathy]]

Cdichang: /* Management */

2020-05-16T01:30:08Z

Management

← Older revision		Revision as of 01:30, 16 May 2020
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	*Management tailored to severity of disease		*Management tailored to severity of disease
	*Maintain euvolemia, [[diuretics]] as needed		*Maintain euvolemia, [[diuretics]] as needed
	*If cardiac function significantly depressed, consider [[~~dopamine~~]] or [[~~dobutamine~~]]		*If cardiac function significantly depressed, consider [[epinephrine]] or [[dopamine]]
	*Consider afterload reduction with [[nitroprusside]] if normotensive		*Consider afterload reduction with [[nitroprusside]] if normotensive
	*Treat [[arrhythmias]]		*Treat [[arrhythmias]]
			**Unstable - cardioversion at 0.5-1 J/kg (max 2J/kg)
			**Stable - consider lidocaine or amiodarone
	**Avoid digoxin due to risk of precipitating more significant dysrhythmias in irritable myocardium		**Avoid digoxin due to risk of precipitating more significant dysrhythmias in irritable myocardium
			*Admit to Pediatric ICU, preferably with ECMO capabilities

	==Disposition==		==Disposition==

Cdichang: /* Evaluation */

2020-05-16T01:06:38Z

Evaluation

← Older revision		Revision as of 01:06, 16 May 2020
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	==Evaluation==		==Evaluation==
			*Blood work
			**Elevated [[troponin]]<ref>Eisenberg MA1, Green-Hopkins I, Alexander ME, Chiang VW. Cardiac troponin T as a screening test for myocarditis in children</ref>
			**Elevated BNP<ref>Koulouri S, Acherman RJ, Wong PC, et al. Utility of B-type natriuretic peptide in differentiating congestive heart failure from lung disease in pediatric patients with respiratory distress. Pediatr Cardiol 2004; 25:341</ref>
			**Markers of inflammation such as ESR and CRP may be elevated, but are nonspecific
			**Elevated [[LFTs]]
			**Blood gas to evaluate for systemic perfusion
	*[[ECG]]		*[[ECG]]
	**[[Sinus tachycardia]] is most common abnormality		**[[Sinus tachycardia]] is most common abnormality
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	*[[Echocardiography]]		*[[Echocardiography]]
	**Unnecessary if both CXR and ECG are normal, unless you have high clinical suspicion		**Unnecessary if both CXR and ECG are normal, unless you have high clinical suspicion
	*Elevated [[LFTs]], [[troponin]] in many cases<ref>Eisenberg MA1, Green-Hopkins I, Alexander ME, Chiang VW. Cardiac troponin T as a screening test for myocarditis in children</ref>

	==Management==		==Management==

Cdichang: /* Evaluation */

2020-05-16T01:02:07Z

Evaluation

← Older revision		Revision as of 01:02, 16 May 2020
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	**[[Sinus tachycardia]] is most common abnormality		**[[Sinus tachycardia]] is most common abnormality
	**Other abnormalities includes<ref>Freedman SB1, Haladyn JK, Floh A, Kirsh JA, Taylor G, Thull-Freedman J. Pediatric myocarditis: emergency department clinical findings and diagnostic evaluation. Pediatrics. 2007 Dec;120(6):1278-85.</ref>		**Other abnormalities includes<ref>Freedman SB1, Haladyn JK, Floh A, Kirsh JA, Taylor G, Thull-Freedman J. Pediatric myocarditis: emergency department clinical findings and diagnostic evaluation. Pediatrics. 2007 Dec;120(6):1278-85.</ref>
	**~~Large~~ voltage		***Low voltage
	**Axis deviation		***Axis deviation
	**ST or [[T wave changes]]		***ST or [[T wave changes]]
	**[[AV blocks]]		***[[AV blocks]] or conduction delays
	**[[myocardial ischemia\|Ischemic]] patterns		***[[myocardial ischemia\|Ischemic]] patterns
			***SVT or ventricular arrhythmias<ref>Batra AS, Epstein D, Silka MJ. The clinical course of acquired complete heart block in children with acute myocarditis. Pediatr Cardiol 2003; 24:495</ref>
	*[[CXR]]		*[[CXR]]
	**Not sensitive, but often abnormal<ref>Durani Y1, Egan M, Baffa J, Selbst SM, Nager AL. Pediatric myocarditis: presenting clinical characteristics. Am J Emerg Med. 2009 Oct;27(8):942-7.</ref>		**Not sensitive, but often abnormal<ref>Durani Y1, Egan M, Baffa J, Selbst SM, Nager AL. Pediatric myocarditis: presenting clinical characteristics. Am J Emerg Med. 2009 Oct;27(8):942-7.</ref>

Cdichang: /* Clinical Features */

2020-05-16T00:56:37Z

Clinical Features

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	==Clinical Features==		==Clinical Features==
	*Symptoms often initially nonspecific in prodromal stage, may be misdiagnosed as [[URI]], [[pneumonia]], [[acute gastroenteritis (peds)\|gastroenteritis]], [[asthma]]		*Symptoms often initially nonspecific in prodromal stage, may be misdiagnosed as [[URI]], [[pneumonia]], [[acute gastroenteritis (peds)\|gastroenteritis]], [[asthma]]
	*Prodrome typically lasts ~~~7 days~~		*Prodrome typically lasts ~1-2 weeks
	*Most common presenting symptoms include <ref>Freedman SB1, Haladyn JK, Floh A, Kirsh JA, Taylor G, Thull-Freedman J. Pediatric myocarditis: emergency department clinical findings and diagnostic evaluation. Pediatrics. 2007 Dec;120(6):1278-85.</ref>		*Most common presenting symptoms include <ref>Freedman SB1, Haladyn JK, Floh A, Kirsh JA, Taylor G, Thull-Freedman J. Pediatric myocarditis: emergency department clinical findings and diagnostic evaluation. Pediatrics. 2007 Dec;120(6):1278-85.</ref>
	**[[Shortness of breath (peds)\|Shortness of breath]]		**[[Shortness of breath (peds)\|Shortness of breath]]
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	**[[URI]] symptoms		**[[URI]] symptoms
	**[[Vomiting]] or [[abdominal pain (peds)\|abdominal pain]]		**[[Vomiting]] or [[abdominal pain (peds)\|abdominal pain]]
			**Exercise intolerance
	**Poor feeding		**Poor feeding
	**Hypoperfusion (e.g. [[syncope]] or [[seizure (peds)\|seizure]]		**Hypoperfusion (e.g. [[syncope]] or [[seizure (peds)\|seizure]]
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	**[[Fever]]		**[[Fever]]
	**[[Respiratory distress]], tachypnea		**[[Respiratory distress]], tachypnea
			***Have a high index of suspicion on the child that has worsening respiratory status after receiving fluids
	**[[Hepatomegaly]]		**[[Hepatomegaly]]
	**Signs of poor perfusion (e.g. decreased cap refill, mottled skin)		**Signs of poor perfusion (e.g. decreased cap refill, mottled skin)

Cdichang: /* Background */

2020-05-16T00:35:51Z

Background

← Older revision		Revision as of 00:35, 16 May 2020
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	==Background==		==Background==
	*Rare but potentially fatal		*Rare but potentially fatal
	*Easily misdiagnosed as viral syndrome, pneumonia
	*Most common cause of heart failure in previously healthy children, also one of the etiologies for unexpected sudden cardiac death		*Most common cause of heart failure in previously healthy children, also one of the etiologies for unexpected sudden cardiac death
	*Inflammation of myocardium		*Inflammation of myocardium

Cdichang: /* Background */

2020-05-16T00:35:06Z

Background

← Older revision		Revision as of 00:35, 16 May 2020
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	==Background==		==Background==
	*Rare but potentially fatal		*Rare but potentially fatal
	*Most common cause of heart failure in previously healthy children		*Easily misdiagnosed as viral syndrome, pneumonia
			*Most common cause of heart failure in previously healthy children, also one of the etiologies for unexpected sudden cardiac death
	*Inflammation of myocardium		*Inflammation of myocardium
	**Can lead to dilated [[cardiomyopathy]]		**Can lead to dilated [[cardiomyopathy]]
	*Typically [[viruses\|viral]] but often no pathogen identified		*Typically [[viruses\|viral]] but often no pathogen identified. Other causes include bacterial, toxins, and autoimmune causes

	==Clinical Features==		==Clinical Features==
	*Symptoms often initially nonspecific in prodromal stage, may be misdiagnosed as [[URI]], [[pneumonia]], [[acute gastroenteritis (peds)\|gastroenteritis]], [[asthma]]		*Symptoms often initially nonspecific in prodromal stage, may be misdiagnosed as [[URI]], [[pneumonia]], [[acute gastroenteritis (peds)\|gastroenteritis]], [[asthma]]