Treatment and prognosis 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. 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'.)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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- NATURAL COURSE AND APPROACH TO MANAGEMENT
- ACUTE MANAGEMENT
- Hemodynamic stability
- - Medical therapy
- - Mechanical support
- Antiarrhythmic drugs
- Directed therapy
- - Antiviral therapies
- - Immunomodulatory therapy
- Intravenous immunoglobulin
- - Our approach
- CHRONIC MANAGEMENT
- Chronic heart disease
- Recurrent disease
- ROUTINE HEALTHCARE ISSUES
- Long-term morbidity
- - Fulminant myocarditis
- SUMMARY AND RECOMMENDATIONS