Pediatria pre prax 3/2019
Diagnosis and treatment of acute myocarditis in children
Both, the diagnosis and treatment of acute myocarditis (AM), are challenging due to its variable course and the inability of any method to confirm or refute the diagnosis of acute myocarditis with sufficient certainty. The most common cause of myocarditis in Central Europe is viral infection. A typical medical history, ECG, echocardiography, cardiac magnetic resonance imaging (cMRI) and troponin T (TrT) are most important in establishing the diagnosis. The variable treatments of AM reflect its variable clinical forms and course. Fulminant myocarditis (FM) is treated aggressively with excellent prognosis. In our centre, immunoglobulins are administered for FM and AM with an ejection fraction (EF) < 40 % for the first 24 – 48 hours. In children with increased TrT, cardiomegaly, left ventricle ejection fraction (LV EF) < 40 % and dilated LV, rapid transfer to a paediatric cardiocenter (DKC) is appropriate before the onset of cardiogenic shock. Mechanical circulatory support or heart transplantation (HTX) may be required. Consistent long-term follow-up of these patients is of paramount importance. Although remarkable advances in diagnosis, understanding of pathophysiological mechanisms and in the treatment of myocarditis have been achieved in recent years, standard treatment strategies are in most cases limited to the treatment of heart failure.
Keywords: acute myocarditis, viral aetiology, serious heart failure, immunoglobulins
