Pediatric myocarditis: presenting clinical characteristics

Durani, Yamini; Egan, Matthew; Baffa, Jeanne; Selbst, Steven M.; Nager, Alan L.

doi:10.1016/j.ajem.2008.07.032

« Previous Next »American Journal of Emergency Medicine
Volume 27, Issue 8 , Pages 942-947, October 2009

Pediatric myocarditis: presenting clinical characteristics

Yamini Durani, MD
- Division of Emergency Medicine, Department of Pediatrics, Alfred I. duPont Hospital for Children, Thomas Jefferson University, Wilmington, DE 19899, USA
- Corresponding author. Tel.: +1 302 651 4296; fax: +1 302 651 4227.
Matthew Egan, MD
- Division of Pediatric Cardiology, Columbus Children's Hospital, Columbus, OH 43205, USA
Jeanne Baffa, MD
- Division of Pediatric Cardiology, Alfred I. duPont Hospital for Children, Thomas Jefferson University, Wilmington, DE 19899, USA
Steven M. Selbst, MD
- Division of Emergency Medicine, Department of Pediatrics, Alfred I. duPont Hospital for Children, Thomas Jefferson University, Wilmington, DE 19899, USA
Alan L. Nager, MD
- Division of Emergency Medicine and Transport Medicine, Department of Pediatrics, Childrens Hospital Los Angeles, Los Angeles, CA 90027, USA
- Keck School of Medicine of the University of Southern California, Los Angeles, CA 90089, USA

Received 23 June 2008; received in revised form 23 July 2008; accepted 24 July 2008.

Abstract

Objective

The objective of the study was to characterize the clinical profiles of pediatric patients with acute myocarditis and dilated cardiomyopathy (DCM) before diagnosis.

Methods

A retrospective cross-sectional study was conducted to identify patients with myocarditis and DCM who presented over a 10-year span at 2 tertiary care pediatric hospitals. Patients were identified based on the International Classification of Diseases, Ninth Revision, diagnostic codes.

Results

A total of 693 charts were reviewed. Sixty-two patients were enrolled in the study. Twenty-four (39%) patients had a final diagnosis of myocarditis, and 38 (61%) had DCM. Of the 62 patients initially evaluated, 10 were diagnosed with myocarditis or DCM immediately, leaving 52 patients who required subsequent evaluation before a diagnosis was determined. Study patients had a mean age of 3.5 years, 47% were male, and 53% were female. Common primary complaints were shortness of breath, vomiting, poor feeding, upper respiratory infection (URI), and fever. Common examination findings were tachypnea, hepatomegaly, respiratory distress, fever, and abnormal lung examination result. Sixty-three percent had cardiomegaly on chest x-ray, and all had an abnormal electrocardiogram results.

Conclusions

These data suggest children with acute myocarditis and DCM most commonly present with difficulty breathing. Myocarditis and DCM may mimic other respiratory or viral illnesses, but hepatomegaly or the finding of cardiomegaly and an abnormal electrocardiogram result may help distinguish these diagnoses from other more common pediatric illnesses.