Pediatric Nonviral Myocarditis Treatment & Management
- Author: Stuart Berger, MD; Chief Editor: P Syamasundar Rao, MD more...
Medical therapy for CHF is fairly standard. The general principles of therapy for CHF are applicable to patients with myocarditis. These principles include the manipulation of preload, afterload, and contractility. Therefore, fluid restriction and diuretics, inotropic support to optimize contractility with continuous intravenous (IV) inotropic agents, and IV vasodilator agents, are all important potential interventions for CHF caused by myocarditis of a nonviral origin.
Additional general maneuvers to reduce the workload of the heart, thereby improving symptoms of CHF, include the following:
Inotropes via continuous drip
Afterload reducing agents
Metabolic demand reduction
Treatment of the specific causes of the myocarditis (ie, bacterial sepsis, rickettsial disease) is necessary. However, it is still not entirely clear if the use of immunosuppressive therapy for myocarditis is indicated.
Some rationale for immunosuppressive therapy for myocarditis has been put forth, because the pathophysiology of myocarditis appears to involve the immune system's reaction against the myocardium. Adult studies have failed to clearly determine the role of immunosuppressive therapy. Some preliminary data suggest that certain combinations of immunosuppressive agents may be beneficial in patients with acute myocarditis.
Surgical care for patient with myocarditis is primarily recommended if medical treatment fails and if the patient is symptomatic.
Surgical treatment may include cardiac transplantation for patients that develop a chronic, symptomatic dilated cardiomyopathy.
Pediatric ventricular assist devices (VADs) have been used as bridges to children with end-stage heart failure, including those resulting from myocarditis.
Another surgical procedure that may be used is left ventricular volume reduction (Battista operation).
Need for and length of inpatient care varies with severity of the illness. Prolonged supportive therapy may be required until the patient can resume spontaneous ventilation and be adequately maintained on oral anticongestive therapy.
Patients require close outpatient follow-up care, especially if significant residual CHF is present. Some patients may continue to have symptoms of moderate to severe CHF that may require eventual cardiac transplantation.
Diet and Activity
Advise patients with chronic, moderate to severe CHF that a "no-added-salt" diet is probably beneficial. Otherwise, ensure adequate calories and nutrition for growth.
During the acute phase of myocarditis, most agree that bed rest should be recommended. Several animal studies have suggested that exercise during the acute viremia can potentiate the disease. However, after recovery and during the healing and/or chronic phases of myocarditis, activity as tolerated is believed to be acceptable.
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