Myocarditis

Cite this article as:
Marc Anders. Myocarditis, Don't Forget the Bubbles, 2013. Available at:
https://doi.org/10.31440/DFTB.3794

See cardiomyopathy , but cardiac MRI or endomyocardial biopsy to confirm diagnosis


Symptoms: 

Very nonspecific in children: malaise, fever, poor appetite, tachypnea, tachycardia, chest pain, abdominal pain, myalgia, fatigue, cough, oedema, hepatomegaly, murmur.


Investigations:

  • See also cardiomyopathy
  • Nonspecific T changes on ECG
  • Cardiac enzymes are not elevated in most patients with myocarditis
  • Echo is mandatory to assess function (systolic and diastolic dysfunction)

Treatment:

1. Symptomatic: see cardiomyopathy

2. IVIG: early, high dose IVIG: 2 g/kg over 24 hrs

3. In chronic DCM: consider interferon with persistent viral genomes


Common differential diagnosis of CM in regards to age:

< 1 year: myocarditis, endocardial fibroelastosis, Barth syndrome, carnitine deficiency, selenium deficiency, anomalous left coronary artery, Kawasaki disease, critical aortic stenosis, supraventricular tachycardia, arterio-venous malformation, calcium deficiency, hypoglycemia, left ventricular non-compaction, mitochondrial cardiomyopathy, nemaline myopathy, minicore-multicore myopathy, myotubular myopathy

> 1 year and < 10 years: familial DCM, Barth syndrome, myocarditis, arrhythmogenic RV dysplasia, endocardial fibroelastosis, carnitine deficiency, selenium deficiency, anomalous left coronary artery, Kawasaki disease, supraventricular tachycardia, toxic (adriamycin), ketothiolase deficiency, ipecac toxicity, systemic lupus erythematosis, polyarteritis nodosa, haemolytic-uraemic syndrome, mitochondrial cardiomyopathy, nemaline myopathy, minicore-multicore myopathy, myotubular myopathy

> 10 years: familial DCM, X-linked DCM, myocarditis, supraventricular tachycardia, congenital heart disease, mitochondrial CM, Chagas disease, arrhythmogenic RV dysplasia, eosinophilic cardiomyopathy, toxic (adriamycin), phaeochromocytoma, Duchenne/Becker muscular dystrophy, Emery-Dreifuss muscular dystrophy, haemochromatosis, limb-girdle muscular dystrophy, myotonic dystrophy, peripartum cardiomyopathy, alcoholic cardiomyopathy


References:

[1] Academic Emergency Medicine, 2008, 15, 355 – 362: Tallmann et all: Noninvasive ventilation outcomes in 2430 acute decompensated heart failure patients: an ADHERE registry analysis

[2] European Journal of Pediatrics, 2010, 169, 269 – 279: Kantor et all: Clinical Practice: Heart Failure in Children. Part I. clinical evaluation, diagnostic testing and initial management

[3] American Journal of Medicine, 2006, 119, S37 – S44: Hill et all: Beyond diuretics: management of volume overload in acute heart failure syndromes

[4] New England Journal of Medicine, 1999, 341, 709 – 717: Pitt et all: The Effect of Spironolactone on Morbidity and Mortality in Patients with Severe Heart Failure

[5] Circulation. 2003;107: 996 – 1002: Hoffmann et all: Efficacy and Safety of Milrinone in Preventing Low Cardiac Output Syndrome in Infants and Children After Corrective Surgery for Congenital Heart Disease

[6] Journal of Intensive Care Medicine, 2006, 21, 183 – 187: Egan et all: Levosimendan for Low Cardiac Output: A Pediatric Experience

[7] Current Cardiology Reviews, 2009, 5, 40 – 44: S. Batra et all: Cardiac Resynchronization Therapy in Children

[8] The Journal of Pediatrics, 2001, 138(4), 457-458: Bruns et all: Carvedilol as therapy in pediatric heart failure: An initial multicenter experience

[9] New England Journal of Medicine, 2006, 355, 1873 – 1884: Birks et all: Left ventricular assist device and drug therapy for the therapy of heart failure

[10] Circulation, 2004, 109, 1250 – 1258: Mahrholdt: Cardiovascular MRI assessment of human myocarditis: a comparison to histology and molecular pathology

[11] Circulation, 1994, 89, 252-257: Drucker et all: Gamma-globulin treatment of acute myocarditis in the pediatric population

[12] Circulation, 2003, 107, 2793 – 2798: Kuhl et all: Interferon-beta treatment eliminates cardiotropic viruses and improves left ventricular function in patient with myocardial persistence of viral genomes and left ventricular dysfunction.


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About Marc Anders

AvatarMarc Anders is a paediatric intensivist.

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Author: Marc Anders Marc Anders is a paediatric intensivist.

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