Clinical manifestations and diagnosis of myocarditis in children
- Catherine K Allan, MD
Catherine K Allan, MD
- Assistant Professor of Pediatrics
- Harvard Medical School
- David R Fulton, MD
David R Fulton, MD
- Section Editor — Pediatric Cardiology
- Associate Professor of Pediatrics
- Harvard Medical School
- Section Editors
- John K Triedman, MD
John K Triedman, MD
- Section Editor — Pediatric Cardiology
- Professor of Pediatrics
- Harvard Medical School
- Sheldon L Kaplan, MD
Sheldon L Kaplan, MD
- Editor-in-Chief — Pediatrics
- Section Editor — Pediatric Infectious Diseases
- Professor and Vice Chairman for Clinical Affairs
- Baylor College of Medicine
Myocarditis is a condition resulting from inflammation of the heart muscle. Myocellular damage results in myocardial dysfunction leading to heart failure. The clinical presentation can be acute or chronic. However, in contrast to adults, the majority of children with myocarditis present with acute or fulminant disease.
The incidence, clinical manifestations, and diagnosis of myocarditis in children are reviewed here. The treatment and prognosis of myocarditis are discussed separately. (See "Treatment and prognosis of myocarditis in children".)
The causes of myocarditis are diverse and include infectious, toxic, and autoimmune etiologies (table 1). Infectious etiologies, particularly viral, are most common in children. The most common causes of viral myocarditis are enterovirus (coxsackie group B), adenovirus, parvovirus B19, Epstein-Barr virus, cytomegalovirus, and human herpes 6 (HHV-6) . Cases may be sporadic or epidemic, and have seasonal and geographical variation [2,3]. Rarely, pediatric myocarditis may be associated with autoimmune disorders and drug hypersensitivity. The etiology and pathogenesis of myocarditis are presented in greater detail separately. (See "Etiology and pathogenesis of myocarditis".)
Myocarditis is rare in children, with an estimated annual incidence of <1 per 100,000 children [4,5]. In a retrospective study from a single tertiary pediatric center, the estimated prevalence of myocarditis among children presenting to their emergency department was 0.5 cases per 10,000 visits . Myocarditis represented 0.3 percent of 14,322 patients seen over a 23-year period at Texas Children’s Hospital . Most studies have a bimodal age distribution with peaks of in infancy and adolescence [8,9].
However, these data likely underestimate the true incidence of pediatric myocarditis since some affected children may have subclinical disease. In addition, the diagnosis can be difficult to establish given the nonspecific symptoms and lack of a sufficiently sensitive and specific diagnostic test for myocarditis. (See 'Diagnosis' below.)To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- CLINICAL MANIFESTATIONS
- - Fulminant myocarditis
- Physical examination
- Initial testing
- - Electrocardiogram
- - Cardiac biomarkers
- - Chest radiograph
- - Echocardiogram
- - Other studies
- Clinical diagnosis
- Endomyocardial biopsy
- - Dallas criteria
- Poor sensitivity
- - Other tests
- - Complications
- - Societal statements
- Magnetic resonance imaging
- Our approach
- FURTHER DIAGNOSTIC EVALUATION
- DIFFERENTIAL DIAGNOSIS
- Acute heart failure
- Respiratory distress
- SOCIETY GUIDELINE LINKS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS