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The evolving approach to paediatric myocarditis: a review of the current literature

Published online by Cambridge University Press:  28 January 2011

Lindsay J. May ,
David J. Patton  and
Deborah S. Fruitman
Lindsay J. May
Affiliation:
Department of Pediatrics, University of Calgary, Alberta Children's Hospital, Calgary, Alberta, Canada
David J. Patton
Affiliation:
Department of Pediatrics, University of Calgary, Alberta Children's Hospital, Calgary, Alberta, Canada Division of Cardiology, University of Calgary, Alberta Children's Hospital, Calgary, Alberta, Canada
Deborah S. Fruitman*
Affiliation:
Department of Pediatrics, University of Calgary, Alberta Children's Hospital, Calgary, Alberta, Canada Division of Cardiology, University of Calgary, Alberta Children's Hospital, Calgary, Alberta, Canada
*
Correspondence to: D.S. Fruitman, MD, FRCP(C), Department of Pediatrics, Division of Cardiology, Alberta Children's Hospital, 2888 Shaganappi Trail NW, Calgary, Alberta T3B 6A8, Canada. Tel: 403 955 7858; Fax: 403 955 7621; E-mail: deborah.fruitman@albertahealthservices.ca
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Abstract

Paediatric myocarditis remains challenging from the perspectives of diagnosis and management. Multiple aetiologies exist and the majority of cases appear to be related to viral illnesses. Enteroviruses are believed to be the most common cause, although cases related to adenovirus may be more frequent than suspected. The clinical presentation is extremely varied, ranging from asymptomatic to sudden unexpected death. A high index of suspicion is crucial. There is emerging evidence to support investigations such as serum N-terminal B-type natriuretic peptide levels, as well as cardiac magnetic resonance imaging as adjuncts to the clinical diagnosis. In the future, these may reduce the necessity for invasive methods, such as endomyocardial biopsy, which remain the gold standard. Management generally includes supportive care, consisting of cardiac failure medical management, with the potential for mechanical support and cardiac transplantation. Treatments aimed at immunosuppression remain controversial. The paediatric literature is extremely limited with no conclusive evidence to support or refute these strategies. This article summarises the current literature regarding aetiology, clinical presentation, diagnosis, and management of myocarditis in paediatric patients.

Keywords

Cardiomyopathymyocardiumventricular dysfunction
Type
Review Article
Information
Cardiology in the Young , Volume 21 , Issue 3 , June 2011 , pp. 241 - 251
Copyright
Copyright © Cambridge University Press 2011

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