Acute Myocarditis in Children: An Overview of Treatment and Recent Patents

Abstract

Background: Pediatric myocarditis is rare but challenging. This overview summarized the current knowledge and recent patents on childhood myocarditis. Methods: We used clinical queries and keywords of “myocarditis” AND “childhood” as search engine. Results: Viral infections are the most common causes of acute myocarditis. Affected children often have a prodrome of fever, malaise, and myalgia. Clinical manifestations of acute myocarditis in children can be nonspecific. Some children may present with easy fatigability, poor appetite, vomiting, abdominal pain, exercise intolerance, respiratory distress/tachypnea, dyspnea at rest, orthopnea, chronic cough with wheezing, chest pain, unexplained tachycardia, hypotension, syncope, and hepatomegaly. Supraventricular arrhythmias, ventricular arrhythmias, and heart block may be present. A subset of patients have fulminant myocarditis and present with cardiovascular collapse which may progress to severe cardiogenic shock, and even death. A high index of suspicion is crucial to its diagnosis and timely management. Cardiac magnetic resonance imaging is important in aiding clinical diagnosis. Endomyocardial biopsy remains the gold standard. Treatment consists of supportive therapy, ranging from supplemental oxygen, fluid restriction to mechanical circulatory support. Angiotensin-converting enzyme inhibitors, angio- tensin II receptor blockers, β-blockers, aldosterone antagonists may have to be used for the treatment of heart failure. Immunosuppression treatments remains controversial. Recent patents related to the management of acute myocarditis are also discussed. There are very few recent patents targeting prevention or treatment of viral myocarditis, including a immunogenic composition comprising a PCV-2 antigen, glutathione-S-transferase P1, neuregulins, NF-[kappa] B inhibitor, a pharmaceutical composition which contains 2-amino-2- (2- (4-octylphenyl) - ethyl) propane 1,3-diol, a composition containing Pycnojenol, Chinese herbal concoctions, and a Korean oral rapamycin. Evidence of their efficacy is still lacking. Conclusions: This article reviews the current literature regarding etiology, clinical manifestations, diagnosis, and management of acute myocarditis in children.

Editorial: Acquired Heart Disease in Children: Pathogenesis, Diagnosis and Management

“…Although it is believed that the pathogenesis of myocarditis may involve abnormal immune reaction to the pathogen, the present views on immunosuppressive therapy with steroids or immunomodulatory therapy with IVIG for treating myocarditis in children are still controversial (3,4). To evaluate the therapeutic response to corticosteroids and IVIG in pediatric myocarditis, Li et al conducted a meta-analysis on the topic.…”