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".)
It is difficult to estimate the incidence of pediatric myocarditis because there is no sensitive and specific diagnostic test for myocarditis. As a result, the diagnosis often is not confirmed. In one retrospective study from a single tertiary pediatric Canadian center, the estimated prevalence of myocarditis presenting to their emergency department was 0.5 cases per 10,000 visits . Other reports suggest an annual incidence of 1 per 100,000 children .
In addition, affected patients may be asymptomatic and found to have evidence of myocarditis after unexpected death [6,7], including infants who were diagnosed with sudden infant death syndrome [8-11]. (See "Sudden cardiac arrest and death in children", section on 'Etiology'.)
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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
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS