THÔNG TIN TÀI LIỆU
Myocarditis Deepa Mokshagundam, John Torrey Berger III Abstract Myocarditis is defined as an inflammatory disease of the myocardium It has many etiologies, including infectious pathogens, toxins, and immunemediated reactions Viruses are the most frequent cause of myocarditis in children The signs and symptoms of myocarditis are highly variable The clinical picture of cardiac failure in a previously healthy child is typical Laboratory evaluation may show signs of a worsening inflammatory state The electrocardiographic abnormalities include sinus tachycardia, lowering of the QRS voltage, widening of the QRS complex, T-wave flattening or inversion, and varying degrees of heart block Echocardiographic features are similar to those found in dilated cardiomyopathy and include dilation of the heart chambers, particularly the left ventricle; global or segmental ventricular dysfunction; and valvar insufficiency Cardiac magnetic resonance imaging with gadolinium enhancement can reveal areas or inflammation, edema, and scarring of the myocardium The place of routine endomyocardial biopsy is controversial If a specific cause of myocarditis is identified and a treatment is available, treatment should be initiated The role of immunomodulatory agents is unclear The goals of treatment include maintenance of adequate oxygen delivery and prevention of cardiac complications such as arrhythmias This may include inotropic agents, diuretics, and/or mechanical ventilation In severe cases or those involving refractory shock, extracorporeal membrane oxygenation may be required If myocardial function does not improve after the initiation of extracorporeal membrane oxygenation, transition to a ventricular assist device and evaluation for heart transplantation may be considered Many children make a full recovery, with clinical signs and symptoms recovering over the course of weeks to months Cardiac enlargement and electrocardiographic findings may take up to a year or more to fully normalize Others may progress to chronic dilated cardiomyopathy Keywords Myocarditis; Dilated cardiomyopathy; Extracorporeal membrane oxygenation; Heart failure; Inflammatory heart disease; Viral myocarditis; Cardiac infections; Autoimmune myocarditis; Systemic lupus erythematosus This chapter discusses inflammatory diseases of the heart, excluding rheumatic fever (see Chapters 55 and 56), Kawasaki disease (see Chapter 54), pericarditis (see Chapter 58), and infectious endocarditis (see Chapter 57) It focuses on those diseases that involve the myocardium either exclusively or predominantly either as a result of a direct effect or secondarily due to toxins or inflammation
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