Pediatric Nonviral Myocarditis Clinical Presentation

Updated: Jul 07, 2019
  • Author: Stuart Berger, MD; Chief Editor: Syamasundar Rao Patnana, MD  more...
  • Print


The clinical presentation of nonviral myocarditis varies considerably; factors that influence the clinical presentation include etiologic agent, age, sex, and immunocompetence. [1, 2, 3, 4] 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


Physical Examination

The physical examination may include verification of the symptoms listed under History. The nonspecific signs and symptoms noted in infants with myocarditis may be evidenced on physical examination but may also be documented in the patient's 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 heart failure

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