This novel simulation-based curriculum targets a gap in pediatric training and offers an effective way to train pediatricians. We plan to expand this curriculum to new populations of participants and have integrated it into our resident cardiology rotation.

Multisystem inflammatory syndrome in children (MIS-C) after COVID-19 is commonly associated with cardiac involvement. Studies found myocardial dysfunction, as measured by decreased ejection fraction and abnormal strain, to be common early in illness. However, there is limited data on longitudinal cardiac outcomes. We aim to describe the evolution of cardiac findings in pediatric MIS-C from acute illness through at least 2-month follow-up. A retrospective single-center review of 36 patients admitted with MIS-C from April 2020 through September 2021 was performed. Echocardiographic data including cardiac function and global longitudinal strain (GLS) were analyzed at initial presentation, discharge, 2-4-week follow-up, and at least 2-month follow-up. Patients with mild and severe disease, normal and abnormal left ventricular ejection fraction (LVEF), and normal and abnormal GLS at presentation were compared. On presentation, 42% of patients with MIS-C had decreased LVEF < 55%. In patients in whom GLS was obtained (N = 18), 44% were abnormal (GLS < |− 18|%). Of patients with normal LVEF, 22% had abnormal GLS. There were no significant differences in troponin or brain natriuretic peptide between those with normal and abnormal LVEF. In most MIS-C patients with initial LVEF < 55% (90%), LVEF normalized upon discharge. At 2-month follow-up, all patients had normal LVEF with 21% having persistently abnormal GLS. Myocardial systolic dysfunction and abnormal deformation were common findings in MIS-C at presentation. While EF often normalized by 2 months, persistently abnormal GLS was more common, suggesting ongoing subclinical dysfunction. Our study offers an optimistic outlook for recovery in patients with MIS-C and carditis, however ongoing investigation for longitudinal effects is warranted.

Care of adults with coronary artery disease focuses on troponins to rapidly move patients to catheterization. Troponins are increasingly drawn in children, but emergent catheterization may not be indicted. We sought to establish etiologies of troponin elevation and ascertain the yield of diagnostic tests, in this population. Retrospective review of patients from January 1, 2002, to December 31, 2011, who had any elevated troponin during the study period. Patients were excluded for recent cardiac surgery, "significant" congenital heart disease, if they were neonates in the NICU or were on ECMO. Twenty-four patients made up our study group: 17/24 (71 %) had myocarditis or cardiomyopathy. Three had coronary-related diagnoses: 1 ALCAPA and 2 Kawasaki syndrome. The most useful testing for making or confirming the diagnoses included ECG, CXR and ECHO. Fourteen had right heart catheterization which was useful in 10/14. Nine had MRI which was useful in 7/9 (all five cases of suspected myocarditis). Left heart catheterization was completed in 10/24 cases, but in no case made or changed the diagnosis. This study confirms that children with elevated troponins differ from adults. The most common cause is myocarditis or cardiomyopathy, whereas coronary-related ischemia is rare. Diagnosis with ECG, CXR and ECHO is typically adequate. Focused use of right heart catheterization and MRI may be useful. In pediatric patients with elevated troponins, left heart catheterization and coronary angiography should be reserved for a highly selective group, and adult "door-to-balloon time" protocols should not be applied routinely.