Myocarditis Flashcards
What is the definition of myocarditis in children?
Inflammation of the heart myocardium
What are some of the etiologic factors for myocarditis in children?
- Infection
- Exposure to toxins
- Or due to autoimmune diseases
What are the most common causes of myocarditis in children?
Infectious causes
What infectious diseases can infect the myocardium leading to myocarditis in children?
Coxsackie group B i.e. and enterovirus, adenovirus, EBV, CMV, parvovirus B19, or HHV type VI. And the SARS-CoV-2 virus can mimic acute viral myocarditis in children with MIS-C.
What medications can cause myocarditis and through what mechanism?
A hypersensitivity reaction with the most common drugs including antibiotics i.e. azithromycin, beta-lactam’s, tetracycline, and minocycline; CNS drugs i.e. benzodiazepines, carbamazepine, phenytoin, clonazepam and TCAs; vaccines including mRNA SARS Cov 2, antituberculosis drugs and diuretics, including furosemide, hydrochlorothiazide.
What are the most common autoimmune diseases presenting with or causing myocarditis as a cardiac complication in children?
Most common autoimmune disease associated myocarditis is systemic lupus, others include granulomatosis with polyangiitis, Takayasu arteritis and giant cell arteritis
What are some of the generalized manifestations or clinical presentation of mild carditis in children?
They may present with signs of heart failure
Supraventricular arrhythmias, ventricular arrhythmias, or complete heart block and finally they may present with hemodynamically compromised cardiac output.
What also is an important part of the history of the most common cause of myocarditis in children?
It is common for patients to have a history of recent viral respiratory or GI illness with symptoms such as fever, malaise, myalgias, abdominal pain or vomiting within the Previous 2 weeks.
What are the signs of heart failure in children?
Dyspnea at rest, tachycardia, tachypnea, exercise intolerance, syncope, or hepatomegaly.
How are the supraventricular arrhythmias, ventricular arrhythmias or complete heart block manifested?
May manifest as physical exam findings, heart failure, and or sudden or unexpected death.
What are the symptoms of becoming hemodynamically compromised from decreased cardiac output?
Hypotension, poor perfusion, weak pulses, acidosis or hepatomegaly. Fulminant myocarditis can lead to cardiogenic shock and death.
Are there any specific physical findings diagnostic of myocarditis in children?
No there are no specific physical findings
What may be some physical findings of myocarditis in children?
Examples may include S3 or S4, heart murmurs or valvular insufficiency such as mitral or tricuspid valve, hypotension, poor perfusion, weak pulses, edema, hepatomegaly, tachypnea, retractions, rales and altered mental states
What is the gold standard for diagnosing myocarditis in children?
And endomyocardial biopsy.
What criteria is used to diagnose a in endomyocardial biopsy specimen for myocarditis?
The Dallas criteria
