• Myocarditis—Child

    Definition

    Myocarditis is an inflammation of the heart’s muscular wall (myocardium). Although rare, it can be devastating. Myocarditis can occur with no symptoms and remain undiagnosed.
    Healthy Myocardium
    normal heart section
    Copyright © Nucleus Medical Media, Inc.

    Causes

    In most children, the condition is often caused by a viral infection. There are different ways a child can become infected. A child may get an infection while in the womb, when viruses can be transferred from mother to baby. Medicines and autoimmune disorders can also cause myocarditis. Sometimes the cause cannot be found.

    Risk Factors

    There are no known risk factors for developing myocarditis.

    Symptoms

    Symptoms vary from person-to-person. They may appear slowly or come on suddenly. How bad the symptoms are may also depend on your child’s age. Children older than two years old may have fewer symptoms compared to babies. This is because a baby’s immune system is less developed to fight an infection. Contact the doctor right away if your child has any of these symptoms:
    • Flu-like complaints, including fever, fatigue, muscle pain, vomiting, diarrhea , and weakness
    • Rapid or irregular heart rate
    • Chest pain
    • Trouble breathing
    • Loss of consciousness
    • Swelling of the face, feet, or legs
    • Abdominal pain
    • Decreased urine output
    Some children may have no symptoms.

    Diagnosis

    There is no specific test for and diagnosis can be hard. Many other causes of heart problems must be ruled out. To do this, the doctor will ask about your child’s symptoms and medical history. She will also do a physical exam.
    Tests may include the following:
    • Electrocardiogram (ECG) —a test that records the heart’s activity by measuring electrical currents through the heart muscle
    • Chest x-ray —a test that uses radiation to take pictures of structures inside the body
    • Cardiac enzyme blood test—certain enzymes may be elevated, showing that the heart muscle is inflamed
    • Other blood tests—to look for signs of infection
    • Echocardiogram —a test that uses high-frequency sound waves (ultrasound) to examine the size, shape, and motion of the heart
    • Biopsy —removal of a sample of heart tissue to test for infection
    • Cardiovascular magnetic resonance—the use of magnetic waves to take pictures of structures inside the body 

    Treatment

    Your child will need bed rest. She should avoid physical activity. Treatment is directed at the underlying cause if possible. For instance:
    • If bacteria are causing the infection, then your child may be given antibiotics.
    • If a virus is causing the infection, then your child may be given antiviral agents.
    • Immunosuppressive therapy may be used if myocarditis is caused by an autoimmune disorder.
    Medicines might be given to support heart function and to remove extra fluid from the lungs or other body tissues.

    Prevention

    Myocarditis is hard to prevent. Reduce exposure to identified causes to help reduce your child’s chances of myocarditis. One way to do this is to practice good hygiene to avoid the spread of infection. For example, have your child wash her hands regularly.

    RESOURCES

    American Heart Association http://www.americanheart.org/

    National Heart, Lung, and Blood Institute http://www.nhlbi.nih.gov/

    CANADIAN RESOURCES

    Canadian Cardiovascular Society http://www.ccs.ca/home/index%5Fe.aspx

    Health Canada http://www.hc-sc.gc.ca/index-eng.php

    References

    Brady WJ, Ferguson JD, Ullman EA, Perron AD. Myocarditis: emergency department recognition and management. Emergency Medicine Clinics of North America . 2004;22(4):865-885.

    Braunwald E, Zipes DP, Libby P, eds. Heart Disease: A Textbook of Cardiovascular Disease . 6th ed. Philadelphia, PA: WB Saunders Company; 2001.

    Cincinnati Children’s Hospital. Myocarditis. Cincinnati Children’s Hospital website. Available at:http://www.cincinnatichildrens.org/health/heart-encyclopedia/disease/myocarditis.htm . Updated September 2009. Accessed June 29, 2010.

    Cohen J, et al. eds. Infectious Diseases . 2nd ed. Edinburgh, Scotland: Elsevier; 2004.

    Drory, Y, Turetz, Y, Hiss, Y, et al. Sudden unexpected death in persons less than 40 years of age. Am J Cardiol . 1991;68:1388.

    Felker GM, Thompson R, Hare J, et al. Underlying causes and long-term survival in patients with initially unexplained cardiomyopathy. N Engl J Med . 2000;342:1077.

    Feldman AM, McNamara D. Myocarditis. N Engl J Med . 2000;343(19):1388-1398.

    Kliegman RM, Jenson HB, Behrman RE, Stanton BF, Editors. Nelson Textbook of Pediatrics . 18th ed. Saunders Elsevier: Philadelphia, PA; 2007.

    Mandell GL, Bennett JE, Dolin R. Principles and Practice of Infectious Diseases . 6th ed. Philadelphia, Pa: Churchill Livingstone; 2005.

    Marx JA, ed. Rosen’s Emergency Medicine: Concepts and Clinical Practice . 5th ed. St. Louis, MO: Mosby, Inc. 2002.

    Myocardim and myocarditis. American Heart Association website. Available at: http://www.americanheart.org/presenter.jhtml?identifier=4729 . Accessed August 4, 2005.

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