Pediatric Pericarditis: Update

Abstract

Purpose of Review While there have now been a variety of large reviews on adult pericarditis, this detailed review specifically focuses on the epidemiology, clinical presentation, diagnosis, and management of pediatric pericarditis. We have tried to highlight most pediatric studies conducted on this topic, with special inclusion of important adult studies that have shaped our understanding of and management for acute and recurrent pericarditis. Recent Findings We find that the etiology of pediatric pericarditis differs from adult patients with pericarditis and has evolved over the years. Also, with the current COVID-19 pandemic, it is important for pediatric clinicians to be aware of pericardial involvement both due to the infection and from vaccination. Oftentimes, pericarditis maybe the only cardiac involvement in children with COVID-19, and so caregivers should maintain a high index of suspicion when they encounter children with pericarditis. Summary Large-scale contemporary epidemiological data regarding incidence and prevalence of both acute and recurrent pericarditis is lacking in pediatrics, and future studies should focus on highlighting this important research gap. Most of the current management strategies for pediatric pericarditis are from experiences gathered from adult data. Pediatric multicenter trials are warranted to understand the best management strategy for those with acute and recurrent pericarditis. Case Vignette A 6-year-old child with a past history of pericarditis almost 2 months ago comes in with a 2-day history of chest pain and fever. Per mother, he stopped his steroids about 2 weeks ago, and for the last 2 days has had a temperature of 102F and has been complaining of sharp mid-sternal chest pain that gets worse when he lies down and is relieved when he sits up and leans forward. On examination, he is tachycardic (heart rate 160 bpm), with normal blood pressure for age. He appears to be in pain (5/10), and on auscultation has a pericardial friction rub. His lab studies are notable for elevated white blood cell count and inflammatory markers (CRP and ESR). His electrocardiogram reveals sinus tachycardia and diffuse ST-elevation in all precordial leads. His echocardiogram demonstrates normal biventricular function and a trace pericardial effusion. His cardiac MRI confirms recurrent pericarditis. He is started on indomethacin and colchicine. He has complete resolution of his symptoms by day 3 of admission and is discharged with close follow-up.

Pediatric Chest Pain: A Review of Diagnostic Tools in the Pediatric Emergency Department

“…While COVID-19 mRNA vaccines are considered highly safe and effective in preventing COVID-19 transmission and severe complications, concerns persist regarding potential adverse effects, particularly myocarditis and pericarditis. Pediatric and adolescent individuals manifesting myocarditis or pericarditis after COVID-19 mRNA vaccination frequently exhibit chest pain (93.3–100.0%), prompting heightened concern among themselves or their families, leading to the pursuit of medical attention [ 106 , 107 , 108 , 109 , 110 , 111 , 112 ].…”

“…Myocarditis or pericarditis tends to occur more frequently in adolescent males (relative risk of 18.2) and after the administration of the second vaccine dose (relative risk of 15.9) [ 106 ]. Moreover, the majority of cases of myocarditis or pericarditis following COVID-19 mRNA vaccination are self-limiting, with recovery observed in 92.6–99.7% of cases without specific treatment [ 106 , 108 , 109 , 110 , 112 , 114 ].…”

Cardiovascular disorders in children with COVID-19

“…Пандемія коронавірусної хвороби, спричинена вірусом SARS-CoV-2, характеризується високою летальністю та широким спектром ускладнень. Найпоширенішими ускладненнями, за даними Chen та співавторів (2022), які проаналізували 187 досліджень із загальним залученням 77 013 пацієнтів, були ураження печінки: 10,00 % (1,39-46,72), 23,04 % (14,(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)13) і 43,48 % (39,88-47,15) у легких, середніх і тяжких випадках, а також гострий респіраторний дистрес-синдром 94,17 % (20,78-99,90) та дихальна недостатність 90,69 % (28,59). Ниркова недостатність (відношення шансів 17,43 (6,43)) і дихальна недостатність (відношення шансів 105, 12 (49,48-223,33)) при супутніх захворюваннях були тісно пов'язані з тяжкими/критичними формами захворювання [1].…”

“…При незначній кількості симптоматика може бути відсутня, але подальше збільшення об'єму викликає серцеву дисфункцію та, зрештою, може призводити до тампонади серця. З іншого боку, сама наявність випоту може свідчити про активність патологічного процесу, який його викликав, як-от локальна запальна реакція, системна запальна відповідь, імуноопосередковані механізми тощо [35]. Ми проаналізували прогностичне значення перикардіального випоту й виявили, що візуалізація вільної рідини у порожнині перикарда асоціювалася з підвищеним ризиком летального перебігу захворювання: ВШ 8,19 (95% ДІ 1,168-48,875).…”

Characteristics of pathological types of breathing in children with community-acquired pneumonia using the "Trembita- Corona" acoustic monitoring device

“…Biological acoustics examines the transmission of sound by organisms. Medical acoustics is dedicated to investigating acoustic phenomena within the medical field (Ahmed et al, 2022;Shahid et al, 2023). In this article, we want to reveal precisely the application of medical acoustics for diagnosing the pathological process in children with САP.…”