Thankavel Poonam P, Mir Arshid, Ramaciotti Claudio
1 Department of Pediatrics, Division of Cardiology, UT Southwestern Medical Center at Dallas, Dallas, Texas, United States of America.
Cardiol Young. 2014 Apr;24(2):283-9. doi: 10.1017/S1047951113000231. Epub 2013 Mar 5.
Myocardial injury in previously healthy children is rare, with a wide range of aetiologies. It is increasingly being identified on the basis of elevated troponin levels during routine evaluation of cardiorespiratory symptoms. Establishing the aetiology remains challenging because of the lack of an accepted work-up algorithm. Our objective was to delineate the contribution of diagnostic modalities and troponin patterns towards the final diagnosis.
A retrospective chart review of previously healthy patients admitted to the Pediatric Cardiology Service with myocardial injury was carried out. Data analysed included echocardiograms, electrocardiograms, cardiac catheterisations, magnetic resonance imaging, drug screen tests, troponin values, and final diagnosis.
A total of 32 patients were identified. The diagnoses were: myocarditis in 16 patients, vasospasm due to drug use in seven, myopericarditis in six, anomalous coronary artery origins in two, and Prinzmetal's angina in one patient. The electrocardiograms were abnormal in 27 of the 32 patients (84%), echocardiograms in 18 of the 32 patients (56%), cardiac magnetic resonance imaging in two of the four patients (50%), urine drug screen in five of the 25 patients (20%), and cardiac catheterisations in two of the 15 patients (13%).
Myocarditis is the most common aetiology of myocardial injury in children. Clinical history remains the basic screening tool; drug screens help identify coronary vasospasms secondary to drug use (22% of our cohort). Patients with anomalous coronaries had exertional symptoms. Initial troponin levels and progression were not diagnostic or prognostic. Catheterisation is of limited value and did not change management. Magnetic resonance imaging with gadolinium enhancement is probably the most useful test when initial evaluation is not diagnostic.
既往健康儿童发生心肌损伤的情况较为罕见，病因广泛。在对心肺症状进行常规评估时，越来越多地通过肌钙蛋白水平升高来发现心肌损伤。由于缺乏公认的检查流程，确定病因仍然具有挑战性。我们的目的是明确诊断方法和肌钙蛋白模式对最终诊断的贡献。
对儿科心脏病科收治的既往健康且发生心肌损伤的患者进行回顾性病历审查。分析的数据包括超声心动图、心电图、心导管检查、磁共振成像、药物筛查试验、肌钙蛋白值以及最终诊断。
共确定32例患者。诊断结果为：16例心肌炎，7例药物所致血管痉挛，6例心肌心包炎，2例冠状动脉起源异常，1例变异型心绞痛。32例患者中27例（84%）心电图异常，32例患者中18例（56%）超声心动图异常，4例患者中2例（50%）心脏磁共振成像异常，25例患者中5例（20%）尿液药物筛查异常，15例患者中2例（13%）心导管检查异常。
心肌炎是儿童心肌损伤最常见的病因。临床病史仍然是基本的筛查工具；药物筛查有助于识别药物所致的冠状动脉痉挛（占我们研究队列的22%）。冠状动脉异常的患者有劳力性症状。初始肌钙蛋白水平及变化情况无助于诊断或判断预后。心导管检查价值有限，且未改变治疗方案。当初始评估不能明确诊断时，钆增强磁共振成像可能是最有用的检查。
