Bejiqi Ramush, Retkoceri Ragip, Maloku Arlinda, Mustafa Aferdita, Bejiqi Hana, Bejiqi Rinor
Medical School, University of Gjakova, Gjakova, Kosovo.
Pediatric Clinic, University Clinical Center of Kosovo, Prishtina, Kosovo.
Open Access Maced J Med Sci. 2019 Jan 4;7(1):162-173. doi: 10.3889/oamjms.2019.010. eCollection 2019 Jan 15.
Myocarditis is an inflammatory disease of the myocardium with a broad spectrum of clinical presentations, ranging from mild symptoms to severe heart failure. The course of patients with myocarditis is heterogeneous, varying from partial or full clinical recovery in a few days to advanced low cardiac output syndrome requiring mechanical circulatory support or heart transplantation. Myocarditis is a very heterogeneous disease, especially in the pediatric age group as worldwide disease myocarditis has been defined by the World Health Organization/International Society and Federation of Cardiology as an inflammatory disease of the heart muscle diagnosed by established histological, immunologic, and immunohistological criteria. Pediatric myocarditis remains challenging from the perspectives of diagnosis and management. Multiple etiologies exist, and the majority of cases appear to be related to viral illnesses. Enteroviruses are believed to be the most common cause, although cases related to adenovirus may be more frequent than suspected. The clinical presentation is extremely varied, ranging from asymptomatic to sudden unexpected death. A high index of suspicion is crucial. There is emerging evidence to support investigations such as serum N-terminal B-type natriuretic peptide levels, as well as cardiac magnetic resonance imaging as adjuncts to the clinical diagnosis. In the future, these may reduce the necessity for invasive methods, such as endomyocardial biopsy, which remain the gold standard. Management generally includes supportive care, consisting of cardiac failure medical management, with the potential for mechanical support and cardiac transplantation. Treatments aimed at immunosuppression remain controversial. The paediatrics literature is extremely limited with no conclusive evidence to support or refute these strategies. All these summarised in this article and the listed current literature showed that there is no consensus regarding aetiology, clinical presentation, diagnosis, and management of myocarditis in pediatric patients.
心肌炎是心肌的一种炎症性疾病，临床表现范围广泛，从轻微症状到严重心力衰竭不等。心肌炎患者的病程具有异质性，从数天内部分或完全临床康复到需要机械循环支持或心脏移植的晚期低心输出量综合征。心肌炎是一种非常异质性的疾病，尤其是在儿童年龄组，因为世界卫生组织/国际心脏病学会和联合会已将全球范围内的疾病性心肌炎定义为一种根据既定的组织学、免疫学和免疫组织学标准诊断的心肌炎症性疾病。从诊断和管理的角度来看，小儿心肌炎仍然具有挑战性。病因多种多样，大多数病例似乎与病毒性疾病有关。肠道病毒被认为是最常见的病因，尽管与腺病毒相关的病例可能比怀疑的更为频繁。临床表现极为多样，从无症状到突然意外死亡。高度的怀疑指数至关重要。越来越多的证据支持进行血清N末端B型利钠肽水平检测以及心脏磁共振成像等检查，作为临床诊断的辅助手段。未来，这些检查可能会减少诸如心内膜心肌活检等侵入性方法的必要性，心内膜心肌活检仍是金标准。治疗通常包括支持性护理，包括心力衰竭的药物治疗，可能还需要机械支持和心脏移植。旨在免疫抑制的治疗仍存在争议。儿科文献极为有限，没有确凿证据支持或反驳这些策略。本文总结的所有这些以及列出的现有文献表明，关于小儿心肌炎的病因、临床表现、诊断和管理尚无共识。
