Viruses are the most common cause of myocarditis in children, according to experts

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Myocarditis in children is a rare but difficult condition to treat. Diagnosis and treatment include multiple options and many cases of myocarditis resolve on their own, according to a new scientific statement from the American Heart Association, “Diagnosis and Management of Myocarditis in Children,” published today in Circulation. The scientific statement writing group reviewed the latest research to develop guidelines in the diagnosis and treatment of myocarditis in children.

Myocarditis is an inflammation of the middle layer of the wall , the myocardium, and can temporarily or permanently weaken the heart muscle and the heart’s electrical system, which keeps the heart pumping regularly. Approximately 10 to 20 per 100,000 people are diagnosed with myocarditis annually in the United States and Canada. , the incidence is 1 to 2 per 100,000. Although many cases resolve on their own or with treatment, leading to a full recovery can lead to severe myocarditis. , abnormal heart rhythms, shock and sudden death. Signs and symptoms of myocarditis include fatigue, shortness of breath, fever, chest pain, and palpitations.

“Myocarditis has different characteristics in children and can have a potential impact on their lifelong health,” said Yuk M. Law, MD, FAHA, chair of the scientific statement writing group, director of the Heart Transplant and Heart Failure at Seattle Children’s Hospital and Professor of Pediatrics at the University of Washington School of Medicine in Seattle. “We hope this statement will serve as an educational update, as well as a unifying call for the necessary research to better understand and treat this important pediatric disease. And, in light of the recently recognized occurrence of myocarditis after COVID infection- 19, as well as the occurrence of suspected cases of myocarditis after vaccination against COVID-19, this statement is a resource for physicians and in the care of these patients “.

Direct tissue examination from a biopsy is the standard for proving the presence of myocarditis, which can also identify if there are viruses. However, less invasive tests are now available. Additional screening tests for myocarditis may include blood tests to measure elevated heart enzymes that indicate inflammation or heart damage, including myoglobin, troponin, and creatine kinase. Imaging tests include an echocardiogram or cardiac magnetic resonance imaging (MRI) to determine if there is any visible injury to the heart or abnormalities in heart function. Electrocardiography (ECG) detection can assess heart rate and may show signs of heart injury as well as signs of pericarditis. Pericarditis is often associated with myocarditis and involves swelling and inflammation of the pericardium, a thin, sac-like tissue structure that surrounds the heart to hold it in place and help it function properly.

Key statement guidelines include:

  • The incidence of myocarditis in children varies with age, being higher in infants and increasing again in infants .
  • Patients should not participate in competitive sports as long as there is active inflammation. In addition to the normalization of markers of inflammatory and myocardial injury, as well as ventricular function and heart failure, 24-hour Holter control and exercise stress tests should be performed on athletes no sooner. 3 to 6 months after diagnosis and before returning to competition.
  • In children, myocarditis is the most common result of a viral infection and is often acute or sudden onset, rather than chronic myocarditis, which is seen more often in adults.
  • Symptoms in children can range from minimal to show signs of heart failure, life-threatening arrhythmias or cardiogenic shock.
  • The most common symptoms of myocarditis in children include fatigue, difficulty breathing, abdominal pain, and fever. (It should be noted that the main symptom reported in patients with suspected myocarditis associated with the COVID-19 vaccine is chest pain.) However, it is important to consider the alternative causes of these symptoms, as none of them it is not specific for cardiovascular conditions, including myocarditis.
  • Acute myocarditis can deteriorate rapidly, so strict follow-up in a hospital should be considered.
  • The first phase of care should include control of atrial or ventricular arrhythmias. Arrhythmia treatment is addressed in the 2017 AHA / ACC / HRS Guide for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death.
  • Acute myocarditis can cause a heart attack similar to a heart attack. Early intervention with mechanical circulatory support (MCS) should be considered in high-risk patients and can save lives.
  • Treatment with antivirals and immunotherapies included and corticosteroids are common; however, additional evidence-based research is needed to more clearly define these treatments for children.
  • Antiviral therapy should be considered if an active viral infection is found.
  • Myocarditis can also be seen as secondary to systemic autoimmune diseases and is associated with rheumatic fever or Kawasaki disease. In these cases, it should be managed according to the indications for the primary disease.
  • During the COVID-19 pandemic, a multisystem inflammatory syndrome in children (MIS-C), a new condition has appeared that affects the myocardium and coronary arteries in some infected patients. Therapy may consist of antivirals, IVIG (intravenous immunoglobulin), steroids, and other anti-inflammatory drugs used in atypical Kawasaki disease.
  • It is recommended to have regular cardiology follow-up, including ECG, echocardiography, and laboratory tests initially every 1 or 3 months after onset, and then as needed.

“Although our work on this scientific claim preceded the COVID-19 pandemic and cases of suspected myocarditis after vaccination against COVID-19 and after COVID-19 infection in adolescents and young adults, the guidelines detailed in this scientific statement can help advise treatment for these patients as well, “Law said.

Specific for suspected cases of myocarditis following vaccination against COVID-19 in recently reported adolescents and young adults who continue to be monitored by the U.S. Centers for Disease Control and Prevention (CDC), the following statement reflects the views of the ‘American Heart Association / American Stroke Association and its scientific leaders.

“The American Heart Association / American Stroke Association recommends that all health care professionals be aware of rare adverse events that may be related to a COVID-19 vaccine, including myocarditis. Healthcare professionals should consider the possibility of ask about the timing of the recent COVID vaccination among patients who have symptoms related to cardiovascular conditions, as needed, to confirm the diagnosis and provide appropriate treatment quickly.According to the CDC, we agree that you should consult cardiologists if you suspect myocarditis or any condition related to the clinical heart care.

“This new scientific statement provides a comprehensive examination of the latest research on the diagnosis, treatment and follow-up of myocarditis in children prior to the COVID-19 era and confirms that myocarditis is a serious but rare condition in children. The effects of COVID -19 Infection includes its life-threatening consequences and possible long-term health effects that are still being revealed, such as conditions that affect the disease. including myocarditis, the brain, vascular system, and other organs.

“We stand firm in our recommendation for all adults and children 12 years of age or older in the U.S. to receive a COVID-19 vaccine as soon as they can receive it, as authorized by the U.S. Food and Drug Administration and recommended by the U.S. CDC., Data continue to indicate that the benefits of COVID-19 vaccination (91% effective in preventing complications of severe COVID-19 infection, including hospitalization and death) far outweigh the risks. rare adverse events, including myocarditis. ”


Questions: COVID-19 vaccination and heart problems


More information:
Yuk M. Law et al, Diagnosis and Management of Myocarditis in Children: A Scientific Statement from the American Heart Association, Circulation (2021). DOI: 10.1161 / CIR.0000000000001001

Citation: Viruses are the most common cause of myocarditis in children, experts offer guidance (2021, July 7) recovered on July 7, 2021 at https://medicalxpress.com/news/2021-07-viruses-common- myocarditis-children-experts. html

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