eMedicine Specialties > Pediatrics: Cardiac Disease and Critical Care Medicine > Cardiology

Myocarditis, Viral: Follow-up

Author: Edwin Rodriguez-Cruz, MD, Assistant Professor, Department of Pediatrics, San Juan Bautista Medical School and Medical Center; Consulting Interventional/Clinical Pediatric Cardiologist, Department of Pediatrics, Hospital El Maestro and San Juan Bautista Medical Center; Consulting Interventional/Clinical Pediatric Cardiologist, Department of Cardiology, Cardiovascular Center of Puerto Rico and the Caribbean and Veterans Affairs Hospital and Medical Center of Puerto Rico
Coauthor(s): Robert D Ross, MD, Co-Director of Pediatric Cardiology Fellowship Program, Department of Pediatrics, Division of Pediatric Cardiology, Professor, Children's Hospital of Michigan and Wayne State University
Contributor Information and Disclosures

Updated: Nov 17, 2009

Follow-up

Further Inpatient Care

  • Discharge patients with viral myocarditis when stable on oral medications.

Further Outpatient Care

  • Monitor medication doses and adverse effects.
  • Serial echocardiography is useful in monitoring ventricular function.

Inpatient & Outpatient Medications

  • Medications include the following, when indicated:
    • Digitalis
    • Afterload reduction agents
    • Diuretics
    • Antiarrhythmics
    • Anticoagulants

Transfer

  • Transfer to a facility with intensive and cardiology care may be required.

Deterrence/Prevention

  • Limit patient activity until recovered.
  • Avoid negative inotropes.
  • Be aware of the possibility of further decrease in ventricular function.

Complications

  • Arrhythmia
  • Congestive heart failure
  • Thromboembolism
  • Further decrease in ventricular function
  • Dilated cardiomyopathy

Prognosis

  • Studies give a wide spectrum of mortality and morbidity statistics.
  • With suspected coxsackievirus B, mortality rate is higher in newborns (75%) than in older infants and children (10-25%).
  • Complete recovery of ventricular function has been reported in as many as 50% of patients.
  • Some patients develop chronic myocarditis (ongoing or resolving), dilated cardiomyopathy, or both. Those who develop dilated cardiomyopathy may require a heart transplant.

Patient Education

  • Restrict activity based on performance after the acute phase.

Miscellaneous

Medicolegal Pitfalls

  • Failure to make a diagnosis

Special Concerns

  • Viral myocarditis may be a fatal disease during pregnancy; however, pregnant women are not at a higher risk of developing viral myocarditis compared with the general population.
 


More on Myocarditis, Viral

Overview: Myocarditis, Viral
Differential Diagnoses & Workup: Myocarditis, Viral
Treatment & Medication: Myocarditis, Viral
Follow-up: Myocarditis, Viral
Multimedia: Myocarditis, Viral
References
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References

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Further Reading

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Keywords

viral myocarditis, myocardium, adenovirus, enterovirus, coxsackievirus, active myocarditis, borderline myocarditis, drug hypersensitivity, Starling law, congestive heart failure, cardiac failure, chronic myocarditis, dilated cardiomyopathy, treatment, diagnosis

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Contributor Information and Disclosures

Author

Edwin Rodriguez-Cruz, MD, Assistant Professor, Department of Pediatrics, San Juan Bautista Medical School and Medical Center; Consulting Interventional/Clinical Pediatric Cardiologist, Department of Pediatrics, Hospital El Maestro and San Juan Bautista Medical Center; Consulting Interventional/Clinical Pediatric Cardiologist, Department of Cardiology, Cardiovascular Center of Puerto Rico and the Caribbean and Veterans Affairs Hospital and Medical Center of Puerto Rico
Edwin Rodriguez-Cruz, MD is a member of the following medical societies: American College of Cardiology, American College of Physicians-American Society of Internal Medicine, American Heart Association, American Medical Association, American Society of Echocardiography, Puerto Rico Medical Association, Society of Cardiac Angiography and Interventions, and Society of Pediatric Echocardiography
Disclosure: Nothing to disclose.

Coauthor(s)

Robert D Ross, MD, Co-Director of Pediatric Cardiology Fellowship Program, Department of Pediatrics, Division of Pediatric Cardiology, Professor, Children's Hospital of Michigan and Wayne State University
Robert D Ross, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American Heart Association, and Society of Pediatric Echocardiography
Disclosure: Nothing to disclose.

Medical Editor

Jeffrey Allen Towbin, MD, MSc, FAAP, FACC, FAHA, Professor, Departments of Pediatrics (Cardiology), Cardiovascular Sciences, and Molecular and Human Genetics, Baylor College of Medicine; Chief of Pediatric Cardiology, Foundation Chair in Pediatric Cardiac Research, Texas Children's Hospital
Jeffrey Allen Towbin, MD, MSc, FAAP, FACC, FAHA is a member of the following medical societies: American Academy of Pediatrics, American Association for the Advancement of Science, American College of Cardiology, American College of Sports Medicine, American Heart Association, American Medical Association, American Society of Human Genetics, Cardiac Electrophysiology Society, New York Academy of Sciences, Society for Pediatric Research, Texas Medical Association, and Texas Pediatric Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Ameeta Martin, MD, Clinical Associate Professor, Department of Pediatric Cardiology, University of Nebraska College of Medicine
Ameeta Martin, MD is a member of the following medical societies: American College of Cardiology
Disclosure: Nothing to disclose.

CME Editor

Gilbert Z Herzberg, MD, Assistant Professor, Department of Pediatrics, Section of Pediatric Cardiology, New York Medical College; Consulting Staff, Department of Pediatrics, Sound Shore Medical Center
Gilbert Z Herzberg, MD is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Chief Editor

Stuart Berger, MD, Professor of Pediatrics, Division of Cardiology, Medical College of Wisconsin; Chief of Pediatric Cardiology, Medical Director of Pediatric Heart Transplant Program, Medical Director of The Heart Center, Children's Hospital of Wisconsin
Stuart Berger, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American College of Chest Physicians, American Heart Association, and Society for Cardiac Angiography and Interventions
Disclosure: Nothing to disclose.

 
 
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