Myocarditis in Paediatric Patients: Unveiling the Progression to Dilated Cardiomyopathy and Heart Failure

Abstract

Myocarditis is a challenging and potentially life-threatening disease associated with high morbidity in some paediatric patients, due to its ability to present as an acute and fulminant disease and to ultimately progress to dilated cardiomyopathy. It has been described as an inflammatory disease of the myocardium caused by diverse aetiologies. Viral infection is the most frequent cause of myocarditis in developed countries, but bacterial and protozoal infections or drug hypersensitivity may also be causative agents. The prompt diagnosis in paediatric patients is difficult, as the spectrum of clinical manifestation can range from no myocardial dysfunction to sudden cardiac death. Recent studies on myocarditis pathogenesis have revealed a triphasic nature of this disease, which influences the diagnostic and therapeutic strategies to adopt in each patient. Endomyocardial biopsy remains the gold standard for diagnosing myocarditis, and several non-invasive diagnostic tools can be used to support the diagnosis. Intravenous immunoglobulin has become part of routine practice in the treatment of myocarditis in paediatric patients at many centres, but its true effect on the cardiac function has been the target of many studies. The aim of this review is to approach the recently discovered facets of paediatric myocarditis regarding its progression to dilated cardiomyopathy.

Differential Expression Profiles and Functional Analysis of Circular RNAS in Children with Fulminant Myocarditis

“…Myocarditis represents myocardial inflammation caused by diverse etiologies; it leads to heart dysfunction and involves reduced systolic and/or diastolic functions, as well as arrhythmias [1]. Fulminant myocarditis, the most serious type of myocarditis, is featured by a rapid disease onset and dramatically accelerated progression, causing highly damaging heart failure, severe alterations in hemodynamics and cardiogenic shock [2].…”

The use of intravenous immunoglobulin therapy in a tertiary pediatric hospital

“…The use of IVIGs in the treatment of acute myocarditis in pediatric patients has been shown to have positive effects on left ventricular functions and survival, and high dosages (2 g/kg) have been recommended. 19,20 In our study, 31 (16.7%) patients with diagnoses of myocarditis received IVIG therapy at dosages of 2 g/kg.…”

Influenza Infection Leading to Cardiac Complications

“…Myocarditis in children may often be missed, as the initial presentation in infants may be nonspecific like fever, poor feeding, irritability, tachycardia and cyanosis. Older children may also complain of chest pain, shortness of breath, abdominal pain, myalgia, arthralgia, palpitations, cough or edema [6]. The spectrum of presentation may vary from being completely asymptomatic to dyspnea, arrhythmias, and florid congestive heart failure leading to cardiogenic shock [7,8].…”