Myocarditis (peds)
This page is for pediatric patients. For adult patients, see: myocarditis
Background
- Rare but potentially fatal
- 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
- Can lead to dilated cardiomyopathy
- Typically viral but often no pathogen identified. Other causes include bacterial, toxins, and autoimmune causes
Clinical Features
- Symptoms often initially nonspecific in prodromal stage, may be misdiagnosed as URI, pneumonia, gastroenteritis, asthma
- Prodrome typically lasts ~1-2 weeks
- Most common presenting symptoms include [1]
- Shortness of breath
- Fever
- URI symptoms
- Vomiting or abdominal pain
- Exercise intolerance
- Poor feeding
- Hypoperfusion (e.g. syncope or seizure
- +/- chest pain, palpitations[2]
- Exam findings include[3]
- Tachycardia
- Fever
- Respiratory distress, tachypnea
- Have a high index of suspicion on the child that has worsening respiratory status after receiving fluids
- Hepatomegaly
- Signs of poor perfusion (e.g. decreased cap refill, mottled skin)
- Lethargy
Differential Diagnosis
Pediatric Shortness of Breath
Pulmonary/airway
- Airway obstruction
- Structural
- Infectious
- Other
Cardiac
- Congenital heart disease
- Vascular ring
- Cardiac tamponade
- Congestive Heart Failure (peds)
- Myocarditis (peds)
Other diseases with abnormal respiration
- Normal neonatal periodic breathing (misinterpreted by caregivers as abnormal)
- Brief resolved unexplained event
- Anemia
- Abdominal distension (e.g. SBO, liver failure
- Neonatal abstinence syndrome
- Decreased perfusion states
- Metabolic acidosis
- CO Poisoning
- Diaphragm injury
- Renal Failure
- Electrolyte abnormalities
- Organophosphate toxicity
- Tick paralysis
- Fever (Peds)
- Panic attack
- Porphyria
Evaluation
- Blood work
- ECG
- Sinus tachycardia is most common abnormality
- Other abnormalities includes[9]
- Low voltage
- Axis deviation
- ST or T wave changes
- AV blocks or conduction delays
- Ischemic patterns
- SVT or ventricular arrhythmias[10]
- CXR
- Not sensitive, but often abnormal[11]
- Cardiomegaly
- Pulmonary edema
- Pleural effusions
- Echocardiography
- Unnecessary if both CXR and ECG are normal, unless you have high clinical suspicion
Management
- Management tailored to severity of disease
- Maintain euvolemia, consider furosemide as needed
- If cardiac function significantly depressed, consider epinephrine or dopamine
- Consider afterload reduction with nitroprusside if normotensive
- 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
- Admit to Pediatric ICU, preferably with ECMO capabilities
Disposition
- Admit, often to ICU
See Also
External Links
References
- ↑ 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.
- ↑ Dancea AB. Myocarditis in infants and children: A review for the paediatrician. Paediatr Child Health. 2001;6(8):543–545. doi:10.1093/pch/6.8.543
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ Shu-Ling C1, Bautista D, Kit CC, Su-Yin AA. Diagnostic evaluation of pediatric myocarditis in the emergency department: a 10-year case series in the Asian population. Pediatr Emerg Care. 2013 Mar;29(3):346-51.
- ↑ Eisenberg MA1, Green-Hopkins I, Alexander ME, Chiang VW. Cardiac troponin T as a screening test for myocarditis in children
- ↑ 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
- ↑ 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.
- ↑ Batra AS, Epstein D, Silka MJ. The clinical course of acquired complete heart block in children with acute myocarditis. Pediatr Cardiol 2003; 24:495
- ↑ 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.