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

Myocardial Infarction in Childhood: Follow-up

Author: Louis I Bezold, MD, Associate Professor, Department of Pediatrics, University of Kentucky College of Medicine; Chief, Division of Pediatric Cardiology, Medical Director, Kentucky Children's Hospital
Coauthor(s): Kurt Pflieger, MD, FAAP, Active Staff, Department of Pediatrics, Lake Pointe Medical Center
Contributor Information and Disclosures

Updated: Oct 8, 2008

Follow-up

Further Inpatient Care

  • The severity of myocardial infarction symptoms at presentation determines whether the patient is admitted to an ICU for aggressive medical management of congestive heart failure (CHF) before surgical revascularization.
  • Initial postoperative treatment is usually performed in a pediatric ICU until the patient is extubated and no longer requires intravenous inotropic support or antiarrhythmics.
  • Following surgical revascularization, postoperative care includes the use of inotropes, diuretics, and afterload reduction medication to improve cardiac output and eliminate the preoperative symptoms of CHF.
  • Monitor patients continuously during the immediate postoperative period because, although unusual, cardiac dysrhythmia secondary to preoperative myocardial ischemia or infarction is a risk.

Further Outpatient Care

  • The clinical status of the patient, in relation to residual CHF symptoms, determines the frequency of postoperative outpatient follow-up visits.
  • Most patients do not require frequent cardiac evaluations following surgical revascularization once ventricular function and mitral valve insufficiency have dramatically improved.
  • For patients with Kawasaki disease, long-term follow-up is recommended, even in cases without evidence of obvious coronary dilatation or aneurysms. Dipyridamole stress scintigraphy may be useful in long-term follow-up and risk stratification in patients with Kawasaki disease.
  • Patients on coronary vasodilators for coronary artery spasm require long-term follow-up.5

Inpatient & Outpatient Medications

  • Short-term use of oral digoxin, diuretics, and ACE inhibitors is common following surgical revascularization.
  • Long-term antiplatelet therapy with aspirin may be needed in conditions predisposed to coronary thrombosis, such as Kawasaki disease with significant aneurysm formation. In patients with giant aneurysms, additional anticoagulation with dipyridamole or warfarin may be recommended. A small retrospective study suggested that combination therapy with warfarin and aspirin was associated with a decreased risk of myocardial infarction in patients with giant aneurysms due to Kawasaki disease.14
  • Coronary spasm is generally treated with nitrates or calcium channel blockade.

Complications

  • Complications are rare. The need for future valve surgery depends on the occurrence of hemodynamic complications (eg, residual mitral valve insufficiency precipitated by permanent damage of the mitral valve architecture) following surgery.
  • Late complications related to coronary artery insufficiency are more likely to occur if revascularization was accomplished via any of the following:
    • Surgical ligation
    • Bypass grafts, which may become occluded or stenotic
    • Intrapulmonary tunnel technique, which may cause supravalvar pulmonary stenosis or, less commonly, obstruction of the surgically created aortopulmonary window
  • Although unlikely, growth of the coronary anastomosis may be inadequate if surgical reimplantation of the left coronary artery is performed. This occurrence is similar to the rare reports of late coronary artery problems following the arterial switch procedure for transposition of the great vessels, which also requires direct coronary transfer and reimplantation.

Prognosis

  • Early diagnosis using echocardiography with color-flow mapping and improvements in surgical techniques (eg, myocardial preservation) dramatically improve the prognosis.

Patient Education

  • All patients should undergo formal exercise stress testing at an appropriate age to aid in determining an appropriate exercise program.
  • Long-term physical restrictions, including restrictions of participation in competitive sports, depend on whether myocardial ischemia is evident at rest or during exercise.
  • No dietary restrictions are necessary following successful surgical revascularization with subsequent clinical improvement.
  • For excellent patient education resources, see eMedicine's Heart Center and Cholesterol Center. Also, visit eMedicine's patient education articles Chest Pain, Coronary Heart Disease, Heart Attack, and Tetralogy of Fallot.
 


More on Myocardial Infarction in Childhood

Overview: Myocardial Infarction in Childhood
Differential Diagnoses & Workup: Myocardial Infarction in Childhood
Treatment & Medication: Myocardial Infarction in Childhood
Follow-up: Myocardial Infarction in Childhood
Multimedia: Myocardial Infarction in Childhood
References
[ CLOSE WINDOW ]

References

  1. Concheiro-Guisan A, Sousa-Rouco C, Fernandez-Santamarina I, Gonzalez-Carrero J. Intrauterine myocardial infarction: unsuspected diagnosis in the delivery room. Fetal Pediatr Pathol. Jul-Aug 2006;25(4):179-84. [Medline].

  2. CDC. National Vital Statistics Report: Acute myocardial infarction. 1998 Nov; 47(9). Available at: http://www.disastercenter.com/cdc/aacutcar.html. Accessed September 30, 2008. [Full Text].

  3. Mahle WT, Campbell RM, Favaloro-Sabatier J. Myocardial infarction in adolescents. J Pediatr. Aug 2007;151(2):150-4. [Medline].

  4. Oglesby P. The international cooperative study on epidemiology. Circulation. Jun 1970;41(6):895-7. [Medline].

  5. Lane JR, Ben-Shachar G. Myocardial infarction in healthy adolescents. Pediatrics. Oct 2007;120(4):e938-43. [Medline].

  6. Hunley TE, Kon V, Jabs K. Myocardial infarction in chronic kidney disease. Pediatrics. Jul 2008;122(1):223-4; author reply 224. [Medline].

  7. Ardoin SP, Sandborg C, Schanberg LE. Management of dyslipidemia in children and adolescents with systemic lupus erythematosus. Lupus. 2007;16(8):618-26. [Medline].

  8. Koestenberger M, Nagel B, Gamillscheg A, Temmel W, Cvirn G, Beitzke A. Myocardial infarction in an adolescent: anomalous origin of the left main coronary artery from the right coronary sinus in association with combined prothrombotic defects. Pediatrics. Aug 2007;120(2):e424-7. [Medline].

  9. Fyfe DA, Ketchum D, Lewis R, et al. Tissue Doppler imaging detects severely abnormal myocardial velocities that identify children with pre-terminal cardiac graft failure after heart transplantation. J Heart Lung Transplant. May 2006;25(5):510-7. [Medline].

  10. Whitham JK, Hasan BS, Schamberger MS, Johnson TR. Use of cardiac magnetic resonance imaging to determine myocardial viability in an infant with in utero septal myocardial infarction and ventricular noncompaction. Pediatr Cardiol. Sep 2008;29(5):950-3. [Medline].

  11. Gazit AZ, Avari JN, Balzer DT, Rhee EK. Electrocardiographic diagnosis of myocardial ischemia in children: is a diagnostic electrocardiogram always diagnostic?. Pediatrics. Aug 2007;120(2):440-4. [Medline].

  12. Towbin JA, Bricker JT, Garson A Jr. Electrocardiographic criteria for diagnosis of acute myocardial infarction in childhood. Am J Cardiol. Jun 15 1992;69(19):1545-8. [Medline].

  13. Lim CW, Ho KT, Quek SC. Exercise myocardial perfusion stress testing in children with Kawasaki disease. J Paediatr Child Health. Jul-Aug 2006;42(7-8):419-22. [Medline].

  14. Sugahara Y, Ishii M, Muta H, Iemura M, Matsuishi T, Kato H. Warfarin therapy for giant aneurysm prevents myocardial infarction in Kawasaki disease. Pediatr Cardiol. Mar 2008;29(2):398-401. [Medline].

  15. Ahn YK, Jeong MH, Bom HS, et al. Myocardial infarction with Moyamoya disease and pituitary gigantism in a young female patient. Jpn Circ J. Aug 1999;63(8):644-8. [Medline].

  16. Bagby GC Jr, Goldman RD, Newman HC, Means JF. Acute myocardial infarction due to childhood lymphoma. N Engl J Med. Aug 17 1972;287(7):338-40. [Medline].

  17. Berenson GS, Srinivasan SR, Hunter SM, et al. Risk factors in early life as predictors of adult heart disease: the Bogalusa Heart Study. Am J Med Sci. Sep 1989;298(3):141-51. [Medline].

  18. Berry CL. Myocardial ischaemia in infancy and childhood. J Clin Pathol. Jan 1967;20(1):38-41. [Medline].

  19. Bex JP, Laborde F, Baillot F, Martelli H, Hazan E. [Myocardial infarction in an infant without coronary artery birth anomalies]. Arch Mal Coeur Vaiss. May 1980;73(5):535-7. [Medline].

  20. Burns JC, Shike H, Gordon JB, et al. Sequelae of Kawasaki disease in adolescents and young adults. J Am Coll Cardiol. Jul 1996;28(1):253-7. [Medline].

  21. Celermajer DS, Sholler GF, Howman-Giles R, Celermajer JM. Myocardial infarction in childhood: clinical analysis of 17 cases and medium term follow up of survivors. Br Heart J. Jun 1991;65(6):332-6. [Medline].

  22. Coggon D, Margetts B, Barker DJ, et al. Childhood risk factors for ischaemic heart disease and stroke. Paediatr Perinat Epidemiol. Oct 1990;4(4):464-9. [Medline].

  23. Dhillon R, Clarkson P, Donald AE, et al. Endothelial dysfunction late after Kawasaki disease. Circulation. Nov 1 1996;94(9):2103-6. [Medline].

  24. Esterly JR, Oppenheimer EH. Some aspects of cardiac pathology in infancy and childhood. IV. Myocardial and coronary lesions in cardiac malformations. Pediatrics. Jun 1967;39(6):896-903. [Medline].

  25. Fukuda T, Ishibashi M, Shinohara T, et al. Follow-up assessment of the collateral circulation in patients with Kawasaki disease who underwent dipyridamole stress technetium-99m tetrofosmin scintigraphy. Pediatr Cardiol. Sep-Oct 2005;26(5):558-64. [Medline].

  26. Garcia RE, Moodie DS. Routine cholesterol surveillance in childhood. Pediatrics. Nov 1989;84(5):751-5. [Medline].

  27. Gattorno M, Falcini F, Ravelli A, et al. Outcome of primary antiphospholipid syndrome in childhood. Lupus. 2003;12(6):449-53. [Medline].

  28. Gunal N, Kara N, Cakar N, et al. Cardiac involvement in childhood polyarteritis nodosa. Int J Cardiol. Aug 8 1997;60(3):257-62. [Medline].

  29. Haitas B, Baker SG, Meyer TE, et al. Natural history and cardiac manifestations of homozygous familial hypercholesterolaemia. Q J Med. Jul 1990;76(279):731-40. [Medline].

  30. Hancock SL, Donaldson SS, Hoppe RT. Cardiac disease following treatment of Hodgkin's disease in children and adolescents. J Clin Oncol. Jul 1993;11(7):1208-15. [Medline].

  31. Hawkins MM, Kingston JE, Kinnier Wilson LM. Late deaths after treatment for childhood cancer. Arch Dis Child. Dec 1990;65(12):1356-63. [Medline].

  32. Isaka N, Nakano T. [Myocardial infarction in childhood]. Ryoikibetsu Shokogun Shirizu. 1996;(12):679-83. [Medline].

  33. Israels SJ, Michelson AD. Antiplatelet therapy in children. Thromb Res. 2006;118(1):75-83. [Medline].

  34. Kampmann C, Kuroczynski W, Trubel H, et al. Late results after PTCA for coronary stenosis after the arterial switch procedure for transposition of the great arteries. Ann Thorac Surg. Nov 2005;80(5):1641-6. [Medline].

  35. Kondo C. Myocardial perfusion imaging in pediatric cardiology. Ann Nucl Med. Oct 2004;18(7):551-61. [Medline].

  36. Kovacs CS, Sanfilippo AJ, Burggraf GW. Anterior wall myocardial infarction in a 15-year-old diabetic female associated with spontaneously resolving coronary thrombosis. Can J Cardiol. Sep 1992;8(7):733-6. [Medline].

  37. Kreutzer U, Krulls-Munch J, Angres M, Schiessler A. [Successful resuscitation of a patient with ventricular fibrillation in Bland-White-Garland syndrome in adulthood. A case report]. Z Kardiol. Jul 1998;87(7):560-5. [Medline].

  38. L'Ecuyer TJ, Poulik JM, Vincent JA. Myocardial infarction due to coronary abnormalities in pulmonary atresia with intact ventricular septum. Pediatr Cardiol. Jan-Feb 2001;22(1):68-70. [Medline].

  39. Lindblade CL, Kirkpatrick EC, Ebenroth ES. Eosinophilic myocarditis presenting with pediatric myocardial infarction. Pediatr Cardiol. Jan-Feb 2006;27(1):162-5. [Medline].

  40. Long WA, Willis PW 4th, Henry GW. Childhood traumatic infarction causing left ventricular aneurysm: diagnosis by two-dimensional echocardiography. J Am Coll Cardiol. Jun 1985;5(6):1478-83. [Medline].

  41. Mavrogeni S, Papadopoulos G, Douskou M, et al. Magnetic resonance angiography, function and viability evaluation in patients with Kawasaki disease. J Cardiovasc Magn Reson. 2006;8(3):493-8. [Medline].

  42. McMahon CJ, Nihill MR, Denfield S. Neoaortic root dilation associated with left coronary artery stenosis following arterial switch procedure. Pediatr Cardiol. Jan-Feb 2003;24(1):43-6. [Medline].

  43. Monagle P. Thrombosis in pediatric cardiac patients. Semin Thromb Hemost. Dec 2003;29(6):547-55. [Medline].

  44. Najean Y, Haguenauer O. Long-term (5 to 20 years) Evolution of nongrafted aplastic anemias. The Cooperative Group for the Study of Aplastic and Refractory Anemias. Blood. Dec 1 1990;76(11):2222-8. [Medline].

  45. Neufeld EJ. Inherited dyslipidemias in childhood. Curr Opin Pediatr. Dec 1993;5(6):707-11. [Medline].

  46. Neufeld HN, Blieden LC. Coronary artery disease in children. Postgrad Med J. Mar 1978;54(629):163-70. [Medline].

  47. Newburger JW, Burns JC. Kawasaki disease. Vasc Med. 1999;4(3):187-202. [Medline].

  48. Newburger JW, Takahashi M, Gerber MA, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Pediatrics. Dec 2004;114(6):1708-33. [Medline]. [Full Text].

  49. Ou P, Mousseaux E, Azarine A, et al. Detection of coronary complications after the arterial switch operation for transposition of the great arteries: first experience with multislice computed tomography in children. J Thorac Cardiovasc Surg. Mar 2006;131(3):639-43. [Medline].

  50. Pahl E, Naftel DC, Kuhn MA, et al. The impact and outcome of transplant coronary artery disease in a pediatric population: a 9-year multi-institutional study. J Heart Lung Transplant. Jun 2005;24(6):645-51. [Medline].

  51. Pfafferott C, Wirtzfeld A, Permanetter B. Atypical Kawasaki syndrome: how many symptoms have to be present?. Heart. Dec 1997;78(6):619-21. [Medline]. [Full Text].

  52. Radford DJ, Sondheimer HM, Williams GJ, Fowler RS. Mucocutaneous lymph node syndrome with coronary artery aneurysm. Am J Dis Child. Jun 1976;130(6):596-8. [Medline].

  53. Schaison G, Jacquillat C, Lemercier N, Weil M, et al. [Acute leukemia in childhood: present status of 100 cases after 7 years of complete remission (author's transl)]. Bull Cancer. 1980;67(3):261-8. [Medline].

  54. Senzaki H, Chen CH, Ishido H, et al. Arterial hemodynamics in patients after Kawasaki disease. Circulation. Apr 26 2005;111(16):2119-25. [Medline]. [Full Text].

  55. Shaukat N, Ashraf S, Mebewu A, et al. Myocardial infarction in a young adult due to Kawasaki disease. A case report and review of the late cardiological sequelae of Kawasaki disease. Int J Cardiol. Jun 1993;39(3):222-6. [Medline].

  56. Simoes MV, Felix PR, Marin-Neto JA. Acute myocardial infarction complicating the clinical course of dilated cardiomyopathy in childhood. Chest. Jan 1992;101(1):271-2. [Medline].

  57. Smith BA, Grider DJ. Sudden death in a young adult: sequelae of childhood Kawasaki disease. Am J Emerg Med. Jul 1993;11(4):381-3. [Medline].

  58. Srinivasan SR, Berenson GS. Serum apolipoproteins A-I and B as markers of coronary artery disease risk in early life: the Bogalusa Heart Study. Clin Chem. Jan 1995;41(1):159-64. [Medline].

  59. Su JT, Chung T, Muthupillai R, et al. Usefulness of real-time navigator magnetic resonance imaging for evaluating coronary artery origins in pediatric patients. Am J Cardiol. Mar 1 2005;95(5):679-82. [Medline].

  60. Takeuchi S, Imamura H, Katsumoto K, et al. New surgical method for repair of anomalous left coronary artery from pulmonary artery. J Thorac Cardiovasc Surg. Jul 1979;78(1):7-11. [Medline].

  61. van Pelt NC, Wilson NJ, Lear G. Severe coronary artery disease in the absence of supravalvular stenosis in a patient with Williams syndrome. Pediatr Cardiol. Sep-Oct 2005;26(5):665-7. [Medline].

  62. Vrsanska V, Bircak J. [Risk factors for cardiovascular diseases in childhood]. Bratisl Lek Listy. Sep 1989;90(9):670-5. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

myocardial infarction, MI, cardiac infarction, acute myocardial infarction, acute MI, juvenile heart disease, pediatric MI, Kawasaki disease, anomalous left coronary artery from the pulmonary artery, ALCAPA, anomalous origin of left coronary artery, coronary artery disease, coronary artery stenosis, myocardial ischemia, cardiac arrest, sudden cardiac death, coronary artery ostial stenosis, D-transposition of the great arteries, d-TGA, aortic root dilation, coronary insufficiency, Marfan syndrome, Takayasu arteritis, cystic medial necrosis, aneurysm, atherosclerosis, presyncope, syncope, cor pulmonale, right heart failure, hepatosplenomegaly, hepatojugular reflux, ascites, Williams syndrome, chronic kidney disease, systemic lupus erythematosus, SLE, transposition of the great arteries, tetralogy of Fallot, left anterior descending coronary artery

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Louis I Bezold, MD, Associate Professor, Department of Pediatrics, University of Kentucky College of Medicine; Chief, Division of Pediatric Cardiology, Medical Director, Kentucky Children's Hospital
Louis I Bezold, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American College of Cardiology, American Heart Association, American Society of Echocardiography, and Society of Pediatric Echocardiography
Disclosure: Nothing to disclose.

Coauthor(s)

Kurt Pflieger, MD, FAAP, Active Staff, Department of Pediatrics, Lake Pointe Medical Center
Kurt Pflieger, MD, FAAP is a member of the following medical societies: American Academy of Pediatrics, American College of Emergency Physicians, American Heart Association, and Texas Medical Association
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, Heart Rhythm 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 broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

Julian M Stewart, MD, PhD, Associate Chairman of Pediatrics, Director, Center for Hypotension, Westchester Medical Center; Professor of Pediatrics and Physiology, New York Medical College
Julian M Stewart, MD, PhD is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

CME Editor

Gilbert Herzberg, MD, Assistant Professor, Department of Pediatrics, Section of Pediatric Cardiology, New York Medical College
Gilbert 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.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.