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Treatment and prognosis of myocarditis in children

Authors
Catherine K Allan, MD
David R Fulton, MD
Section Editors
John K Triedman, MD
Sheldon L Kaplan, MD
Deputy Editor
Carrie Armsby, MD, MPH

INTRODUCTION

Myocarditis is a condition resulting from inflammation of the heart muscle. Myocellular damage results in myocardial dysfunction leading to heart failure. In contrast to adults, the majority of children with myocarditis present with acute or fulminant disease usually due to a viral infection. Children with myocarditis are at risk for arrhythmias and hemodynamic compromise, resulting in significant morbidity and mortality.

The natural course, management, and prognosis of myocarditis in children are reviewed here. The causes, incidence, clinical manifestations, and diagnosis of myocarditis in children are discussed separately. (See "Etiology and pathogenesis of myocarditis" and "Clinical manifestations and diagnosis of myocarditis in children".)

NATURAL COURSE AND APPROACH TO MANAGEMENT

Viral myocarditis can be considered a continuum of two or three disease processes, which transition from one to another in a seamless manner [1,2]. (See "Etiology and pathogenesis of myocarditis", section on 'Viral myocarditis and dilated cardiomyopathy'.)

Viral infection phase is often reported as a prodromal presentation of fever, myalgia, and malaise several days prior to the onset of symptoms of heart dysfunction. Respiratory and gastrointestinal symptoms are also common in this phase. Viral infection may result in direct myocyte injury. (See "Clinical manifestations and diagnosis of myocarditis in children", section on 'Presentation'.)

The use of antiviral agents has been proposed; however, their efficacy is unproven in the treatment of myocarditis [3]. (See 'Antiviral therapies' below.)

                       

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Literature review current through: Nov 2016. | This topic last updated: Thu Feb 18 00:00:00 GMT+00:00 2016.
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References
Top
  1. Liu PP, Mason JW. Advances in the understanding of myocarditis. Circulation 2001; 104:1076.
  2. Canter CE, Simpson KE. Diagnosis and treatment of myocarditis in children in the current era. Circulation 2014; 129:115.
  3. Caforio AL, Pankuweit S, Arbustini E, et al. Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J 2013; 34:2636.
  4. de Caen AR, Berg MD, Chameides L, et al. Part 12: Pediatric Advanced Life Support: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2015; 132:S526.
  5. Duncan BW, Bohn DJ, Atz AM, et al. Mechanical circulatory support for the treatment of children with acute fulminant myocarditis. J Thorac Cardiovasc Surg 2001; 122:440.
  6. Grundl PD, Miller SA, del Nido PJ, et al. Successful treatment of acute myocarditis using extracorporeal membrane oxygenation. Crit Care Med 1993; 21:302.
  7. del Nido PJ, Armitage JM, Fricker FJ, et al. Extracorporeal membrane oxygenation support as a bridge to pediatric heart transplantation. Circulation 1994; 90:II66.
  8. Hetzer R, Loebe M, Potapov EV, et al. Circulatory support with pneumatic paracorporeal ventricular assist device in infants and children. Ann Thorac Surg 1998; 66:1498.
  9. Rajagopal SK, Almond CS, Laussen PC, et al. Extracorporeal membrane oxygenation for the support of infants, children, and young adults with acute myocarditis: a review of the Extracorporeal Life Support Organization registry. Crit Care Med 2010; 38:382.
  10. Morales DL, Almond CS, Jaquiss RD, et al. Bridging children of all sizes to cardiac transplantation: the initial multicenter North American experience with the Berlin Heart EXCOR ventricular assist device. J Heart Lung Transplant 2011; 30:1.
  11. Ghelani SJ, Spaeder MC, Pastor W, et al. Demographics, trends, and outcomes in pediatric acute myocarditis in the United States, 2006 to 2011. Circ Cardiovasc Qual Outcomes 2012; 5:622.
  12. Miyake CY, Teele SA, Chen L, et al. In-hospital arrhythmia development and outcomes in pediatric patients with acute myocarditis. Am J Cardiol 2014; 113:535.
  13. Anderson BR, Silver ES, Richmond ME, Liberman L. Usefulness of arrhythmias as predictors of death and resource utilization in children with myocarditis. Am J Cardiol 2014; 114:1400.
  14. Saul JP, Scott WA, Brown S, et al. Intravenous amiodarone for incessant tachyarrhythmias in children: a randomized, double-blind, antiarrhythmic drug trial. Circulation 2005; 112:3470.
  15. Chen HS, Wang W, Wu SN, Liu JP. Corticosteroids for viral myocarditis. Cochrane Database Syst Rev 2013; :CD004471.
  16. Weller AH, Hall M, Huber SA. Polyclonal immunoglobulin therapy protects against cardiac damage in experimental coxsackievirus-induced myocarditis. Eur Heart J 1992; 13:115.
  17. George J, Barshack I, Malka E, et al. The effect of intravenous immunoglobulins on the progression of experimental autoimmune myocarditis in the rat. Exp Mol Pathol 2001; 71:55.
  18. Robinson J, Hartling L, Vandermeer B, Klassen TP. Intravenous immunoglobulin for presumed viral myocarditis in children and adults. Cochrane Database Syst Rev 2015; :CD004370.
  19. Drucker NA, Colan SD, Lewis AB, et al. Gamma-globulin treatment of acute myocarditis in the pediatric population. Circulation 1994; 89:252.
  20. Klugman D, Berger JT, Sable CA, et al. Pediatric patients hospitalized with myocarditis: a multi-institutional analysis. Pediatr Cardiol 2010; 31:222.
  21. Active and Passive Immunization. In: Red Book: 2012 Report of the Committee on Infectious Diseases, 29th, Pickering LK. (Ed), American Academy of Pediatrics, Elk Grove Village, IL 2012. p.37.
  22. Lin AH, Phan HA, Barthel RV, et al. Myopericarditis and pericarditis in the deployed military member: a retrospective series. Mil Med 2013; 178:18.
  23. Taylor CL, Eckart RE. Chest pain, ST elevation, and positive cardiac enzymes in an austere environment: differentiating smallpox vaccination-mediated myocarditis and acute coronary syndrome in Operation Iraqi Freedom. J Emerg Med 2012; 42:267.
  24. Gagliardi MG, Bevilacqua M, Bassano C, et al. Long term follow up of children with myocarditis treated by immunosuppression and of children with dilated cardiomyopathy. Heart 2004; 90:1167.
  25. Lee KJ, McCrindle BW, Bohn DJ, et al. Clinical outcomes of acute myocarditis in childhood. Heart 1999; 82:226.
  26. Kleinert S, Weintraub RG, Wilkinson JL, Chow CW. Myocarditis in children with dilated cardiomyopathy: incidence and outcome after dual therapy immunosuppression. J Heart Lung Transplant 1997; 16:1248.
  27. Venugopalan P, Houston AB, Agarwal AK. The outcome of idiopathic dilated cardiomyopathy and myocarditis in children from the west of Scotland. Int J Cardiol 2001; 78:135.
  28. English RF, Janosky JE, Ettedgui JA, Webber SA. Outcomes for children with acute myocarditis. Cardiol Young 2004; 14:488.
  29. Lipshultz SE, Sleeper LA, Towbin JA, et al. The incidence of pediatric cardiomyopathy in two regions of the United States. N Engl J Med 2003; 348:1647.
  30. Nugent AW, Daubeney PE, Chondros P, et al. The epidemiology of childhood cardiomyopathy in Australia. N Engl J Med 2003; 348:1639.
  31. Foerster SR, Canter CE, Cinar A, et al. Ventricular remodeling and survival are more favorable for myocarditis than for idiopathic dilated cardiomyopathy in childhood: an outcomes study from the Pediatric Cardiomyopathy Registry. Circ Heart Fail 2010; 3:689.
  32. Amabile N, Fraisse A, Bouvenot J, et al. Outcome of acute fulminant myocarditis in children. Heart 2006; 92:1269.
  33. Teele SA, Allan CK, Laussen PC, et al. Management and outcomes in pediatric patients presenting with acute fulminant myocarditis. J Pediatr 2011; 158:638.