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
- Inflammation of myocardium
- Can lead to dilated cardiomyopathy
- Typically viral but often no pathogen identified
Clinical Features
- Symptoms often initially nonspecific in prodromal stage, may be misdiagnosed as URI, pneumonia, gastroenteritis, asthma
- Prodrome typically lasts ~7 days
- Most common presenting symptoms include [1]
- Shortness of breath
- Fever
- URI symptoms
- Vomiting or abdominal pain
- Poor feeding
- Hypoperfusion (e.g. syncope or seizure
- +/- chest pain, palpitations[2]
- Exam findings include[3]
- Tachycardia
- Fever
- Respiratory distress, tachypnea
- Hepatomegaly
- Signs of poor perfusion (e.g. decreased cap refill, mottled skin)
- Lethargy
Differential Diagnosis
Pulmonary/airway
- Airway obstruction
- Anaphylaxis, angioedema
- Aspirated foreign body
- Asthma exacerbation
- Pneumonia
- Pneumothorax
- Respiratory distress syndrome
- Meconium aspiration syndrome
- Bronchiolitis (peds), URI
- Pertussis
- Bronchopulmonary dysplasia
- Croup
- Epiglottitis
- Bacterial tracheitis
- Tracheomalacia
- Cystic fibrosis exacerbation
- Pulmonary edema
- Pulmonary hypertension, cor pulmonale
- Inhalation exposure
- Rib fractures, Flail chest, pulmonary contusion
- Neoplasm
Cardiac
- Congenital heart disease
- Vascular ring
- Cardiac tamponade
- Cardiogenic pulmonary edema (CHF)
- 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
- ECG
- Sinus tachycardia is most common abnormality
- Other abnormalities includes[7]
- Large voltage
- Axis deviation
- ST or T wave changes
- AV blocks
- Ischemic patterns
- CXR
- Not sensitive, but often abnormal[8]
- Cardiomegaly
- Pulmonary edema
- Pleural effusions
- Echocardiography
- Unnecessary if both CXR and ECG are normal, unless you have high clinical suspicion
- Elevated LFTs, troponin in many cases[9]
Management
- Management tailored to severity of disease
- Maintain euvolemia, diuretics as needed
- If cardiac function significantly depressed, consider dopamine or dobutamine
- Consider afterload reduction with nitroprusside if normotensive
- Treat arrhythmias
- Avoid digoxin due to risk of precipitating more significant dysrhythmias in irritable myocardium
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.
- 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.
- 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.
- Eisenberg MA1, Green-Hopkins I, Alexander ME, Chiang VW. Cardiac troponin T as a screening test for myocarditis in children
This article is issued from
Wikem.
The text is licensed under Creative
Commons - Attribution - Sharealike.
Additional terms may apply for the media files.