Cardiology Presentation. Myocarditis - A Review of Management in Paediatrics. Case 1. Three month old female, HIV IC2 but not yet on HAART, admitted on the 1/7/07 with a 4 day history of - cough - shortness of breath - diarrhoea
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Myocarditis - A Review of Management in Paediatrics
- shortness of breath
Length 57cm ( =10th)
generalised significant lymphadenopathy
tip of spleen
RUL and LUL consolidation
2/7/2007: CK 606; CKMB 44%; Trop T <0.03
3/7/2007: CK 514; CKMB 100%; Trop T <0.03
5/7/2007: CK 680; CKMB 59%; Trop T <0.03
Normal intracardiac anatomy
- cough and blocked nose
- vomited once
Birthweight of 2750g
Apex beat 4th interspace, mid-clavicular line; normal heart sounds; no gallop
Trop T 0.21
- Poor LV function
- Normal intracardiac anatomy
Assessment of probable myocarditis was made on basis of poor LV function, and Polygam was ordered as well as digoxin
So why then should physicians concern themselves with a disease that is clinically uncommon, diagnostically challenging and that has an excellent recovery?!
Influenza A and B
Bacteria: Beta-hemolytic Streptococcus
Protozoa highly variable disease entity.: Trypanosoma cruzii
Helminths: Trichinella spiralis
Autoimmunity: Infection associated
Auto-immune disease associated
Phase 1 highly variable disease entity.
Phase 2 highly variable disease entity.
Phase 3 highly variable disease entity.
- Active myocarditis: > 14 leucocytes/mm with necrosis and degeneration
- Chronic myocarditis >14 leucocytes/mm but no necrosis or degeneration
Diagnosis continued: highly variable disease entity.
5. Myocarditis affects persons of all ages, and disease and treatment response vary between children and adults.
6. Previous trials show an improvement in myocarditis with conservative treatment. Therefore difficult to interpret the effectiveness of IS in studies without a control group.
7. The validity of the historical gold standard of endomyocardial biopsy as the basis of diagnosis if conservative therapies are the standard treatment?
Randomised Treatment Trial on Myocarditis (ESETCID) treatment response vary between children and adults.
- acute viral infection no IS is given