Acute Myocarditis in Childhood and Adolescence in the Covid-19 Era

Abstract

Myocarditis in children and adolescents is an inflammatory myocardial disease with a heterogeneous presentation ranging from oligosymptomatic, with no impaired ejection fraction to catastrophic clinical presentation with cardiogenic shock (fulminant myocarditis) or sudden death. Thus, this condition remains a major challenge from the diagnostic and therapeutic points of view. Despite the different etiologies listed, the most frequent form may be related to viral diseases, and new forms of myocarditis, such allergic ones (eosinophilic and use of medications, particularly cancer immunotherapy), have been currently described. Increasing the rate of suspicion is crucial. Measurement of serum levels of troponin and N-terminal B-type natriuretic peptide, as well as the use of advanced methods of cardiac imaging, such as strain echocardiogram, positron emission tomography, and cardiac magnetic resonance, are integral part of multimodal assessment in suspected patients. Although endomyocardial biopsy remains is still the gold standard for disease diagnosis, currently it tends to be performed in specific situations, such as fulminant clinical presentation and chronic or recurrent myocarditis. The management of this condition includes general supportive care, treatment of heart failure, control of arrhythmias when present, assessment of mechanical support and cardiac transplantation. Treatments based on immunosuppression and immunotherapy are still controversial. In this article, we propose a broad review of diagnostic and treatment methods, as well as the different etiologies in the pediatric population.

Pediatric Cardiomyopathies: Establishing Genotype-Phenotype Relationship as a Determinant in Prognosis and Therapy: A Review of the Literature

“…The age of symptom onset is fundamental to investigation of etiology, because infants present with inborn errors of metabolism more frequently than older children. [1][2][3]29,30,31 Family history is essential, and some patients may be diagnosed early thanks to family history, even in the absence of symptoms, due to family screening. The importance of this early diagnosis is due to the possibility of primary prevention of sudden death, which may be the first and only symptom in some cases.…”

“…Higher levels are associated with worse prognosis. 31,37,38 The morphofunctional phenotype should be determined using available cardiac imaging tools such as electrocardiogram; echocardiogram with color Doppler, tissue Doppler (to assess diastolic dysfunction), and speckle tracking (to assess early systolic dysfunction and subclinical systolic dysfunction); and cardiac magnetic resonance, which characterizes myocardial tissue and detects edema and fibrosis. It is worth noting that the measurements obtained must be expressed in z-scores for proper interpretation.…”