Acute Myocarditis and Pericarditis in Children

Abstract

1. Hari Tunuguntla, MD, MPH* 2. Aamir Jeewa, MD† 3. Susan W. Denfield, MD* 1. *Department of Pediatrics, Division of Pediatric Cardiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX 2. †Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada * Abbreviations: CMR: : cardiovascular magnetic resonance imaging DCM: : dilated cardiomyopathy ECG: : electrocardiogram EMB: : endomyocardial biopsy IVIg: : intravenous immunoglobulin MCS: : mechanical circulatory support PCR: : polymerase chain reaction PHIS: : Pediatric Health Care Information System VAD: : ventricular assist device 1. The diagnoses of myocarditis and pericarditis are often delayed because they are uncommon diseases in pediatrics and because symptoms in the early stages may be overlooked in the context of current or recent viral illnesses or other systemic diseases. Early suspicion for and recognition of signs and symptoms, particularly of myocarditis, are important because the disease process can rapidly become life-threatening. Although pericarditis can also be life-threatening, it is less commonly so than myocarditis. 2. Clinicians should be aware of the predisposing factors and the clinical signs and symptoms that should increase the index of suspicion for these entities because prompt referral to the emergency department, with access to specialists with expertise in the care and support of these patients, is imperative. After completing this article, readers should be able to: 1. Recognize the context in which myocarditis and pericarditis arise in a differential diagnosis. 2. Identify causes of myocarditis and pericarditis. 3. Recognize clinical signs and symptoms of myocarditis and pericarditis. 4. Appropriately refer patients to the emergency department for further evaluation. Myocardial and pericardial diseases are uncommon problems in childhood that can present as isolated diagnoses or as part of systemic diseases. Although they can have the same etiologies, and symptoms often overlap, their prognosis and treatment differ significantly. It is important to make an accurate diagnosis because clinically apparent myocarditis is much more likely to be life-threatening, and rapidly so, than pericarditis. Children with suspected myocarditis or pericarditis should be sent to an emergency department, where access to specialists with expertise in these diseases is available. The key is early suspicion for these entities to make a timely referral and diagnosis …