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Pediatric Nonviral Myocarditis Clinical Presentation

  • Author: Stuart Berger, MD; Chief Editor: P Syamasundar Rao, MD  more...
 
Updated: Mar 30, 2015
 

History

The clinical presentation of nonviral myocarditis varies considerably; factors that influence the clinical presentation include etiologic agent, age, sex, and immunocompetence. Many patients with myocarditis are asymptomatic, whereas others may present with a fulminant, rapidly progressive, fatal illness.

Clinical manifestations of myocarditis, regardless of etiology, tend to be more severe in newborns than in older infants and children. Symptoms in newborns are nonspecific and include the following:

  • Lethargy
  • Poor feeding
  • Cyanosis
  • Respiratory distress
  • Tachypnea
  • Tachycardia
  • Vomiting

In older infants and children, the symptoms often encountered include the following:

  • Low-grade fever
  • Irritability
  • Mild respiratory symptoms
  • Abdominal pain
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Physical Examination

The physical examination may include verification of the symptoms listed in the previous section. The nonspecific signs and symptoms noted in infants with myocarditis may be evidenced on physical examination but may also be documented in patient history. Fever, irritability, respiratory signs, and abdominal pain may be noted on physical examination of children and adults with myocarditis. If the disease has progressed, physical examination usually reveals the following:

  • Decreased cardiac output
  • Pallor and cool skin in distal extremities
  • Rapid respirations
  • Possible thready pulse
  • Tachycardia usually present (gallop rhythm may be heard)
  • Progressive CHF

A mitral regurgitant murmur--a blowing, holosystolic murmur heard best at the apex of the heart--may be present. Lung examination may show scattered rhonchi and rales. Full cardiovascular collapse is possible.

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Contributor Information and Disclosures
Author

Stuart Berger, MD Medical Director of The Heart Center, Children's Hospital of Wisconsin; Associate Professor, Department of Pediatrics, Section of Pediatric Cardiology, Medical College 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, Society for Cardiovascular Angiography and Interventions

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

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.

Chief Editor

P Syamasundar Rao, MD Professor of Pediatrics and Medicine, Division of Cardiology, Emeritus Chief of Pediatric Cardiology, University of Texas Medical School at Houston and Children's Memorial Hermann Hospital

P Syamasundar Rao, MD is a member of the following medical societies: American Academy of Pediatrics, American Pediatric Society, American College of Cardiology, American Heart Association, Society for Cardiovascular Angiography and Interventions, Society for Pediatric Research

Disclosure: Nothing to disclose.

Additional Contributors

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 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, New York Academy of Sciences, Society for Pediatric Research, Texas Medical Association, Texas Pediatric Society, Cardiac Electrophysiology Society

Disclosure: Nothing to disclose.

References
  1. Blauwet LA, Cooper LT. Myocarditis. Prog Cardiovasc Dis. 2010 Jan-Feb. 52(4):274-88. [Medline].

  2. Shamna RB, Lalitha AV, Lini B. Myocarditis in Children. Indian J Pediatr. 2013 Sep 26. [Medline].

  3. Libman E, Sacks B. A hitherto undescribed form of valvular and mural endocarditis. Arch Intern Med. 1974. 33:701-37.

  4. Klugman D, Berger JT, Sable CA, et al. Pediatric patients hospitalized with myocarditis: a multi-institutional analysis. Pediatr Cardiol. 2010 Feb. 31(2):222-8. [Medline].

  5. Sachdeva S, Song X, Dham N, Heath DM, DeBiasi RL. Analysis of clinical parameters and cardiac magnetic resonance imaging as predictors of outcome in pediatric myocarditis. Am J Cardiol. 2015 Feb 15. 115(4):499-504. [Medline].

  6. Crossman DJ, Ruygrok PN, Hou YF, Soeller C. Next-generation endomyocardial biopsy: the potential of confocal and super-resolution microscopy. Heart Fail Rev. 2015 Mar. 20(2):203-14. [Medline].

  7. [Guideline] Heart Failure Society Of America. Myocarditis: Current treatment. J Card Fail. 2006 Feb. 12(1):e120-2. [Medline].

  8. Frustaci A, Pieroni M, Chimenti C. Immunosuppressive treatment of chronic non-viral myocarditis. Ernst Schering Res Found Workshop. 2006. 343-51. [Medline].

  9. Miller JR, Lancaster TS, Eghtesady P. Current approaches to device implantation in pediatric and congenital heart disease patients. Expert Rev Cardiovasc Ther. 2015 Apr. 13(4):417-27. [Medline].

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Myocarditis with scarring, autopsy. The image is a short axis gross photograph of an 8-year-old child with clinical myocarditis showing scarring of both ventricles, more prominent in the left. The fibrosis shows a random distribution with epicardial, myocardium, and pericardial involvements.
 
 
 
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