Acute myocarditis in adolescents

Czech version

Authors: S. Mlynárová ¹; S. Polanská ¹; J. Pavlíček ^1,2; P. Hanzlíková ^2,3; P. Širůček ^2,4; T. Gruszka ^1,2; M. Hladík ^1,2
Authors‘ workplace: Klinika dětského lékařství, Fakultní nemocnice Ostrava ¹; Lékařská fakulta, Ostravská univerzita, Ostrava ²; Ústav radiodiagnostický, Fakultní nemocnice Ostrava ³; Klinika infekčního lékařství, Fakultní nemocnice Ostrava ⁴
Published in: Čes-slov Pediat 2021; 76 (1): 18-27.
Category: Original Papers

Overview

Acute myocarditis is a potentially serious disease. The course is very variable, the most common etiology is viral. The authors present three cases of acute myocarditis that occurred in adolescent boys in a short period. The common symptomatology was chest pain, higher levels of troponin were detected in all of them, and all had a positive MRI finding. In two cases, significant Coxsackievirus titers were demonstrated serologically and in one, primary infection with Epstein-Barr virus was confirmed. The clinical course was without complications, for non-altered heart function we assume a good prognosis in all patients. Lifelong monitoring is recommended.

Keywords:

infection – magnetic resonance imaging – myocarditis – Troponin

Sources

1. Levine MC, Klugman D, Teach SJ. Update on myocarditis in children. Curr Opin Pediatr 2010; 22 (3): 278–283.

2. Ukimura A, Kishi K, Yamada T, et al. National survey of influenza myocarditis in Japanese children in three season. Clin Microbial 2014; 3: 143.

3. Feigin VL, Roth GA, Naghavi M, et al. Global burden of stroke and risk factors in 188 countries, during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet Neurol 2016; 15 (9): 913–924.

4. Stiller B. Managment of myocarditis in children: the current situation. Adv Exp Med Biol 2008; 609: 196–215.

5. Chaloupecký V, et al. Dětská kardiologie. Praha: Galén, 2006.

6. Breinholt JP, Moulik M, Dreyer WJ, et al. Viral epidemiologic shift in inflammatory heart disease: the interesting involvement of parvovirus B19 in the myocardium of pediatric cardiac transplant patients. J Heart Lung Transplant 2010; 29:739–746.

7. Kunovský P, Olejník P. Diagnostika a liečba akútnej myokarditídy u detí. Pediatr Prax 2019; 20 (3): 122–127.

8. Krejčí J, Poloczková H. Inflammatory myocardial disease. Vnitr Lek 2019; 65 (10): 636–642.

9. Banka P, Robinson JD, Uppu SC, et al. Cardiovascular magnetic resonance techniques and findings in children with myocarditis: a multicenter retrospective study. J Cardiovasc Magn Reson 2015; 17: 96.

10. 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 (33): 2636–2648.

11. Aretz HT. Myocarditis: the Dallas criteria. Hum Pathol 1987; 18 (6): 619–624.

12. Vos T, Barber RM, Bell B, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2015; 386 (9995): 743–800.

13. Freedman SB, Haladyn JK, Floh A, et al. Pediatric myocarditis: emergency department clinical findings and diagnostic evaluation. Pediatrics 2007; 120 (6): 1278–1285.

14. Al-Akchar M, Kiel J. Acute Myocarditis. In StatPearls 2018. https: //www.ncbi.nlm.nih.gov/books/NBK441847/.

15. Magnani JW, Danik HJS, Dec Jr GW, DiSalvo TG. Survival in biopsy-proven myocarditis: a long-term retrospective analysis of the histopathologic, clinical, and hemodynamic predictors. Am Heart J 2006; 151 (2): 463–470.

16. Caforio AL, Calabrese F, Angelini A, et al. A prospective study of biopsy-proven myocarditis: prognostic relevance of clinical and aetiopathogenetic features at diagnosis. Eur Heart J 2007; 28 (11): 1326–1333.

17. Hufnagel G, Pankuweit S, Richter A, et al. The European Study of Epidemiology and Treatment of Cardiac Inflammatory Diseases (ESETCID). First epidemiological results. Herz 2000; 25 (3): 279–285.

18. Mahrholdt H, Wagner A, Deluigi CC, et al. Clinical perspective. Circulation 2006; 114 (15): 1581–1590.

19. Soongswang J, Durongpisitkul K, Nana A, et al. Cardiac troponin T: a marker in the diagnosis of acute myocarditis in children. Pediatr Cardiol 2005; 26 (1): 45–49.

20. Simpson KE, Canter CE. Acute myocarditis in children. Expert Rev Cardiovasc Ther 2011; 9 (6): 771–783.

21. Kane DA, Fulton DR, Saleeb S, et al. Needles in hay: chest pain as the presenting symptom in children with serious underlying cardiac pathology. Congenit Heart Dis 2010; 5 (4): 366–373.

22. Felker GM, Boehmer JP, Hruban RH, et al. Echocardiographic findings in fulminant and acute myocarditis. J Am Coll Cardiol 2000; 36 (1): 227–232.

23. Schultz JC, Hilliard AA, Cooper Jr LT, Rihal CS. Diagnosis and treatment of viral myocarditis. Mayo Clin Proc 2009; 84 (11): 1001–1009.

24. Dominguez F, Kühl U, Pieske B, et al. Update on myocarditis and inflammatory cardiomyopathy: reemergence of endomyocardial biopsy. Rev Esp Cardiol (Engl Ed) 2016; 69 (2): 178–187.

25. Zhorne D, Petit CJ, Ing FF, et al. A 25‐year experience of endomyocardial biopsy safety in infants. Catheter Cardio Interv 2013; 82 (5): 797–801.

26. Maisch B, Bultman B, Factor S, et al. World Heart Federation consensus conference‘s definition on inflammatory cardiomyopathy (myocarditis): report from two expert committees on histology and viral cardiomyopathy. Heartbeat 1999; 4: 3–4.

27. Frustaci A, Russo MA, Chimenti C. Randomized study on the efficacy of immunosuppressive therapy in patients with virus-negative inflammatory cardiomyopathy: the TIMIC study. Eur Heart J 2009; 30: 1995–2002.

28. Das BB. Role of endomyocardial biopsy for children presenting with acute systolic heart failure. Pediatr Cardiol 2014; 35 (2): 191–196.

29. JCS Joint Working Group. Guidelines for diagnosis and treatment of myocarditis. Circ J 2011; 1102021098-1102021098.

30. Cooper LT, Baughman KL, Feldman AM, et al. The role of endomyocardial biopsy in the management of cardiovascular disease: a scientific statement from the American Heart Association, the American College of Cardiology, and the European Society of Cardiology Endorsed by the Heart Failure Society of America and the Heart Failure Association of the European Society of Cardiology. J Am Coll Cardiol 2007; 50 (19): 1914–1931.

31. From AM, Maleszewski JJ, Rihal CS. Current status of endomyocardial biopsy. Mayo Clin Proc 2011; 86 (11): 1095–1102.

32. Mahrholdt H, Goedecke C, Wagner A, et al. Cardiovascular magnetic resonance assessment of human myocarditis: a comparison to histology and molecular pathology. Circulation 2004; 109 (10): 1250–1258.

33. Sparrow PJ, Merchant, N, Provost YL, et al. CT and MR imaging findings in patients with acquired heart disease at risk for sudden cardiac death. Radiographics 2009; 29 (3): 805–823.

34. Friedrich MG, Sechtem U, Schulz-Menger J, et al. Cardiovascular magnetic resonance in myocarditis: A JACC White Paper. J Am Coll Cardiol 2009; 53 (17): 1475–1487.

35. Vashist S, Singh GK. Acute myocarditis in children: current concepts and management. Curr Treat Options Cardiovasc Med 2009; 11 (5): 383–391.

36. Natale L, De Vita A, Baldari C, et al. Correlation between clinical presentation and delayed-enhancement MRI pattern in myocarditis. Radiol Med 2012; 117 (8): 1309–1319.

37. Feldman A, McNamara D. Myocarditis. N Engl J Med 2000; 343: 1388–1398.

38. Fairweather D, Stafford KA, Sung YK. Update on Coxsackie B3 myocarditis. Curr Opin Rheumatol 2012; 24: 401–407.

39. Ginsberg F, Parrillo JE. Fulminant myocarditis. Crit Care Clin 2013; 29 (3): 465–483.

40. Beneš J, et al. Infekční lékařství. 1. vyd. Praha: Galén, 1990: 1–442.

41. Amabile N, Fraisse A, Bouvenot J, et al. Outcome of acute fulminant myocarditis in children. Heart 2006; 92 (9): 1269–1273.

42. Kouba K, et al. Infekční mononukleóza. Praha: Avicenum, 1988: 126–129.

43. Kühn B, Shapiro ED, Walls TA, Friedman AH. Predictors of outcome of myocarditis. Pediatr Cardiol 2004; 25 (4): 379–384.

44. English RF, Janosky JE, Ettedgui JA, Webber SA. Outcomes for children with acute myocarditis. Cardiol Young 2004; 14 (5): 488–493.

45. McNamara DM, Holubkov R, Starling RC, et al. Controlled trial of intravenous immuneglobulin in recent-onset dilated cardiomyopathy. Circulation 2001; 103: 2254–2259.

46. Klugman D, Berger JT, Sable CA, et al. Pediatric patients hospitalized with myocarditis: a multi-institutional analysis. Pediatr Cardiol 2010; 31 (2): 222–228.