Clinical Presentation of Myocarditis in the Pediatric Age Group and Predictors of Poor Early and Late Outcomes: Academic Hospital Experience

Alamri, Aliaa S; Khayat, Luay T; Alzahrani, Ahad J; Kurdi, Lujain K; Alkhameesi, Najwa F; Bahaidarah, Saud A.

doi:10.7759/cureus.31643

Cited by 4 publications

(4 citation statements)

References 27 publications

(79 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Studies show that between 52.9% and 85.7% of pediatric myocarditis patients have cardiomegaly on their chest X-ray. [ 18 , 19 ]. According to Durani et al, cardiomegaly was present in 63% of the patients with viral myocarditis [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical Presentation, Diagnosis, Treatment, and Outcomes of Myocarditis in Children: A Tertiary Care Hospital Experience

Khan,

Hussain,

Ilyas

et al. 2024

Cureus

View full text Add to dashboard Cite

Background Clinical presentation, diagnosis, and treatment of myocarditis in children can be highly challenging, and results can vary greatly. Research on the precise processes of myocardial injury, including the effects of viral infections and newly identified variables like COVID-19, is still underway. Though treatment approaches, such as immunosuppressive therapy, are still debatable, diagnostic methods such as cardiac MRI and biomarkers show promise in improving diagnostic accuracy. The purpose of this study is to describe the spectrum of pediatric acute myocarditis, assess existing therapy approaches, and develop regional guidelines based on the experience of a tertiary care institution. Methods Children diagnosed with acute myocarditis over a six-month period were included in this retrospective and descriptive hospital-based study. Data on demographics, clinical presentations, diagnostic tests, treatments, and results were gathered and examined. Descriptive statistics, non-parametric tests for categorical variables, and Spearman's correlation tests for continuous data were used in the statistical analysis, with a significance level of p < 0.05. Results Of the 99 patients included, the mean age was 2.37 years, with males making up the majority (n = 54, 54.55%). Clinical symptoms typically included shortness of breath (n = 998, 99.0%), vomiting (n = 63, 63.6%), and chest pain (n = 6, 6.1%). High levels of troponin I (n = 70, 70.7%), cardiomegaly on a chest X-ray (n = 97, 97.0%), and different degrees of ventricular dysfunction were found in the laboratory and in imaging studies. Methylprednisolone (n = 84, 84.8%) and IV immunoglobulin (n = 54, 54.5%) were the most often used treatment modalities, and there were no appreciable differences in the two treatment groups' outcomes. A weak negative association (Spearman's rho = -0.211, p = 0.036) was found in the correlation study between the administration of methylprednisolone and length of stay (LOS), indicating possible benefits in terms of shortening hospital stays. Conclusion This research offers a significant understanding of the clinical manifestation, treatment, and complications of acute myocarditis in children. Methylprednisolone administration seems to be linked to a shorter length of stay (LOS), despite disagreements over treatment approaches. To confirm these results and provide guidance for evidence-based management guidelines for pediatric myocarditis in our setup, more studies are necessary.

show abstract

Section: Discussionmentioning

confidence: 99%

Clinical Presentation, Diagnosis, Treatment, and Outcomes of Myocarditis in Children: A Tertiary Care Hospital Experience

Khan,

Hussain,

Ilyas

et al. 2024

Cureus

View full text Add to dashboard Cite

show abstract

“…Because symptoms and clinical findings are typically ambiguous, diagnosing myocarditis in children is difficult [15]. Smaller children frequently exhibit respiratory or gastrointestinal symptoms, while infants frequently exhibit restlessness, poor feeding, or symptoms that resemble a severe bacterial infection [16].…”

Section: Discussionmentioning

confidence: 99%

Clinical Presentation of Myocarditis in Children Visiting Dr Ruth KM PFAU, Civil Hospital, Karachi. A Cross-Sectional Study

Ahmed¹,

Raza²,

Yahya³

et al. 2022

PJMHS

View full text Add to dashboard Cite

Objective: To determine the frequency of various clinical presentations of myocarditis in children visiting to Dr Ruth KM PFAU, Civil Hospital Karachi. Study design: Cross-Sectional Study. Place and duration: Department of Pediatric Medicine, Dr Ruth K.M PFAU Civil Hospital, Karachi, Pakistan from September, 2020, to March, 2021 Methodology: The study covered all patients who visited Karachi's Civil Hospital and met the inclusion criteria. After describing the study's process, hazards, and benefits, informed consent was obtained. The initial ECG, echocardiography, and cardiac enzyme readings were all documented. Stroke, congenital heart disease, sepsis, asthma, pulmonary embolism, cardiomyopathy, gastroenteritis, diabetes mellitus, and renal failure were among the clinical presentations that were noted. The proforma that is supplied at the end was filled out with all the acquired data and used electronically for research. Results: Age was 6.8± 2.1 years on average. A total of 238 (67.6%) of the 352 patients were male, and 114 (32.4%) were female. In patients with myocarditis who presented clinically, renal disease was found in 46 (13.1%), cardiomyopathy in 30, congenital heart disease in 56 (15.9%), stroke in 41 (11.5%), gastroenteritis in 65 (18.5%), diabetes mellitus in 19 (5.4%), sepsis in 32 (9.2%), and asthma in 48 (13.6%) patients, while pulmonary embolism was found in 15 (4.3%) patients. Practical implication There is growing evidence to support the use of tests such as cardiac magnetic resonance imaging and serum N-terminal B-type natriuretic peptide measurements as supplements to clinical diagnosis. These could eventually lessen the need for invasive procedures like endomyocardial biopsy, which is still the gold standard. Conclusion: The most frequent clinical manifestation of myocarditis was gastroenteritis, which was followed by congenital heart disease and asthma. For the purpose of validating the results so far, additional extensive research is advised. Keywords: Clinical Presentation, Myocarditis, Epidemiology, Asthma, Gastroenteritis

show abstract

“…In about 83% of children's cases, the diagnosis of myocarditis is not made at the first visit to the doctor, but usually takes two or more visits to the doctor before the diagnosis of myocarditis is made [119]. As in adults, the symptoms and signs of myocarditis can be non-specific.…”

Section: Myocarditis In Childrenmentioning

confidence: 99%

“…The clinical picture may include dyspnea, vomiting, and the appearance of diarrhea [120]. The occurrence of dysrhythmias is common in the pediatric population with myocarditis and indicates a worse prognosis of the disease [119]. According to the studies of S. Aliaa et al, the largest number of children (76.5%) presents with symptoms and signs of congestive HF without hemodynamic instability, while 11.8% of patients develop a fulminant form of the disease [119].…”

Section: Myocarditis In Childrenmentioning

confidence: 99%

Update on Myocarditis: From Etiology and Clinical Picture to Modern Diagnostics and Methods of Treatment

Lasica,

Djukanovic,

Savic

et al. 2023

Diagnostics

View full text Add to dashboard Cite

Although the frequency of myocarditis in the general population is very difficult to accurately determine due to the large number of asymptomatic cases, the incidence of this disease is increasing significantly due to better defined criteria for diagnosis and the development of modern diagnostic methods. The multitude of different etiological factors, the diversity of the clinical picture, and the variability of the diagnostic findings make this disease often demanding both for the selection of the diagnostic modality and for the proper therapeutic approach. The previously known most common viral etiology of this disease is today overshadowed by new findings based on immune-mediated processes, associated with diseases that in their natural course can lead to myocardial involvement, as well as the iatrogenic cause of myocarditis, which is due to use of immune checkpoint inhibitors in the treatment of cancer patients. Suspecting that a patient with polymorphic and non-specific clinical signs and symptoms, such as changes in ECG and echocardiography readings, has myocarditis is the starting point in the diagnostic algorithm. Cardio magnetic resonance imaging is non-invasive and is the gold standard for diagnosis and clinical follow-up of these patients. Endomyocardial biopsy as an invasive method is the diagnostic choice in life-threatening cases with suspicion of fulminant myocarditis where the diagnosis has not yet established or there is no adequate response to the applied therapeutic regimen. The treatment of myocarditis is increasingly demanding and includes conservative methods of treating heart failure, immunomodulatory and immunospressive therapy, methods of mechanical circulatory support, and heart transplantation. The goal of developing new diagnostic and therapeutic methods is to reduce mortality from this complex disease, which is still high.

show abstract

Clinical Presentation of Myocarditis in the Pediatric Age Group and Predictors of Poor Early and Late Outcomes: Academic Hospital Experience

Cited by 4 publications

References 27 publications

Clinical Presentation, Diagnosis, Treatment, and Outcomes of Myocarditis in Children: A Tertiary Care Hospital Experience

Clinical Presentation, Diagnosis, Treatment, and Outcomes of Myocarditis in Children: A Tertiary Care Hospital Experience

Clinical Presentation of Myocarditis in Children Visiting Dr Ruth KM PFAU, Civil Hospital, Karachi. A Cross-Sectional Study

Update on Myocarditis: From Etiology and Clinical Picture to Modern Diagnostics and Methods of Treatment

Contact Info

Product

Resources

About