Alamri Aliaa S, Khayat Luay T, Alzahrani Ahad J, Kurdi Lujain K, Alkhameesi Najwa F, Bahaidarah Saud A
Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU.
Pediatrics, Faculty of Medicine, King Abdulaziz University Hospital, Jeddah, SAU.
Cureus. 2022 Nov 18;14(11):e31643. doi: 10.7759/cureus.31643. eCollection 2022 Nov.
Myocarditis is a leading cause of morbidity and mortality in the pediatric age group and contributes to a wide range of complications, including dilated cardiomyopathy, congestive heart failure, and even death, so early identification and comprehensive management are essential for a favorable outcome.
Summarize the presenting clinical signs and symptoms of pediatric patients with a diagnosis of myocarditis and a poor outcome and correlate the clinical presentation and laboratory and radiographic findings to identify possible predictors of a poor outcome.
This retrospective cohort study included all patients who were diagnosed with myocarditis and followed up at King Abdulaziz University Hospital, Jeddah, Saudi Arabia over the 13 years between January 01, 2007, and December 31, 2019. Information on patient demographics, clinical presentation, and non-invasive investigations was obtained. Poor outcomes were defined as death or evidence of left ventricular dysfunction on echocardiography which was evaluated at two points in time as an early outcome and a late outcome.
Seventeen patients (male 52.9%, female 47.1%) with a median age of 4 ± 4.31 years are included. The most frequent initial complaints were exercise or feeding intolerance, respiratory symptoms, and shortness of breath. On the other hand, hepatomegaly and respiratory distress were the most common clinical signs. All the patients were admitted to the pediatric intensive care unit but only 41% required mechanical ventilation. The presence of a murmur at presentation was significantly correlated with a poor early outcome. Ischemic changes on the electrocardiogram and moderate left ventricular dysfunction on the echocardiogram were significantly correlated with a poor late outcome.
Diagnosis of myocarditis can be established by a combination of clinical presentation and investigative tools. A murmur, ischemic changes on the electrocardiogram, and left ventricular dysfunction are important predictors of myocarditis in children.
心肌炎是儿童年龄组发病和死亡的主要原因，可导致多种并发症，包括扩张型心肌病、充血性心力衰竭甚至死亡，因此早期识别和综合管理对于取得良好预后至关重要。
总结诊断为心肌炎且预后不良的儿科患者的临床表现和症状，并将临床表现与实验室及影像学检查结果相关联，以确定可能的不良预后预测因素。
这项回顾性队列研究纳入了2007年1月1日至2019年12月31日这13年间在沙特阿拉伯吉达阿卜杜勒阿齐兹国王大学医院被诊断为心肌炎并接受随访的所有患者。获取了患者人口统计学、临床表现和非侵入性检查的信息。不良预后定义为死亡或超声心动图显示左心室功能障碍的证据，在两个时间点进行评估，作为早期结局和晚期结局。
纳入了17例患者（男性占52.9%，女性占47.1%），中位年龄为4±4.31岁。最常见的初始主诉是运动或喂养不耐受、呼吸道症状和呼吸急促。另一方面，肝肿大和呼吸窘迫是最常见的临床体征。所有患者均入住儿科重症监护病房，但只有41%需要机械通气。就诊时出现杂音与早期不良结局显著相关。心电图上的缺血性改变和超声心动图上的中度左心室功能障碍与晚期不良结局显著相关。
心肌炎的诊断可通过临床表现和检查手段相结合来确立。杂音、心电图上的缺血性改变和左心室功能障碍是儿童心肌炎的重要预后预测因素。
