Pediatric Viral Myocarditis - Causes, Symptoms, Diagnosis, and Treatment

Introduction

Myocarditis is also referred to as inflammatory cardiomyopathy- a disease of the heart that develops due to inflammatory changes that occur in the muscles of the heart, called myocardium. Pediatric viral myocarditis refers to pediatric viral myocarditis that arises because of viral infection in the pediatric age group. This disease is slightly more common in young males as compared to females. The majority of the cases of pediatric viral myocarditis are mild in nature, with symptoms varying from shortness of breath to arrhythmias (irregular heartbeat). The mean duration of the disease may last between hours to several months. The complications of pediatric viral myocarditis include cardiovascular failure and cardiac arrest. One of the most common causes of pediatric viral myocarditis is a viral infection that has not been treated, diagnosed or has been long-standing. The treatment is based on the severity as well as the underlying cause. Medications involved are generally diuretics and beta-blocking agents. A span of no physical exercise is recommended post-treatment and during recovery.

How Does Pediatric Viral Myocarditis Affect the Heart?

Pediatric viral myocarditis is a condition that results in the swelling of the heart muscles. This swelling or inflammation expands as well as exhausts the heart. It generates scar tissue and compels the heart to work vigorously to smoothly circulate oxygen and blood all through the body. Pediatric viral myocarditis affects young adults, children, and newborns. It is prevalent in males and, surprisingly, in young athletes in their early 30s. One of the chief reasons for sudden death in young adults and children is myocarditis.

What Are the Causes of Pediatric Viral Myocarditis?

The most common etiological factor of pediatric viral myocarditis is an infectious organism. Viral infections are one of the most common reasons for the development of this disease all around the globe, with the majority of cases being diagnosed with a single-stranded RNA gene, such as Coxsackie virus, Coxsackie B3, and Coxsackie B5. Several other viral infections that lead to pediatric viral myocarditis are mentioned below.

• Adenovirus.

• Parvovirus B19.

• Coxsackie virus.

• Rubella virus.

• Polio virus.

• Epstein-Barr virus.

• Hepatitis C virus.

• Severe acute respiratory syndrome.

• Corona virus.

• CMV or cytomegalovirus.

• Herpes simplex virus.

• Human immunodeficiency virus.

• Parvovirus.

• Chlamydia.

What Are the Signs and Symptoms of Pediatric Viral Myocarditis?

The clinical manifestation that is associated with pediatric viral myocarditis varies and depends on the inflammation of the myocardium as well as the weakness of the heart muscle. While pediatric viral myocarditis can develop anywhere between a few hours to several months, patients typically present with the below-mentioned signs and symptoms.

• Fainting.

• Damage to the heart cells.

• Abnormal heartbeat.

• Dizziness.

• Sharp stabbing kind of pain in the chest.

• Shortness of breath.

• Palpitations.

• Swelling in the ankles, legs, and feet.

• Fatigue.

• Pressure in the chest.

• Fever.

• Tachycardia (increased heart rate).

• Bradycardia (decreased heart rate).

• Atrial fibrillation.

• Diarrhea.

• Sore throat.

• Muscle aches.

• Joint pain.

• Extended neck veins.

• Decreased urinary output.

• Dull heart sounds.

• Arrhythmias.

• Rash.

• Loss of appetite.

• Fatigue.

• Abdominal discomfort.

• Vomiting.

How to Diagnose Pediatric Viral Myocarditis?

The correct diagnosis of pediatric viral myocarditis is made after the healthcare provider has taken a thorough medical history, especially cardiovascular history. In addition, understanding the patient’s symptoms and conducting physical examinations, as well as several tests, are necessary to diagnose a case of pediatric viral myocarditis. Mentioned below are some of the go-to diagnostic tools for pediatric viral myocarditis.

• Electrocardiogram.

• Cardiac enzyme markers.

• Complete blood picture.

• Echocardiogram.

• Rheumatological screening tests.

• Viral blood tests.

• Heart muscle biopsy.

• Chest x-rays.

• Lung and other chest structures examination.

• MRI of the heart or magnetic resonance imaging of the heart.

How to Treat Pediatric Viral Myocarditis?

While pediatric viral myocarditis has several etiological factors as well as an array of signs and symptoms, a few of the causes are treatable and acquire the primary focus. A thorough medical and physical examination, along with a detailed case history, is extremely crucial. Mentioned below are a few of the treatment and management modalities of pediatric viral myocarditis. It should be noted that after a critical evaluation of the entire cardiovascular system, the healthcare professional may suggest the insertion of a pacemaker or an implantable loop recorder. The best person to make this decision is the cardiologist and a team of multidisciplinary doctors. The decision is purely based on the outcome of pediatric viral myocarditis episodes and the underlying cause. Reexamination and reevaluation of the patient's cardiovascular system are highly recommended in order to ensure full recovery of heart function.

• Corticosteroids.

• Medications to benefit autoimmune and systemic conditions.

• Use of inotropes.

• Antiarrhythmic drugs.

• Angiotensin-converting enzyme inhibitors.

• Antibiotic therapy.

• Beta-blockers.

• Diuretics.

• Aldosterone receptor blockers.

• Digoxin.

• Intra-aortic balloon pumps.

• Extracorporeal membrane oxygenation or ECMO.

• Heart transplantation.

What Are the Complications of Pediatric Viral Myocarditis?

Pediatric viral myocarditis must never be left undiagnosed and untreated. There are recorded cases of pediatric viral myocarditis leading to heart failure if not treated according to the underlying condition. In rare cases, the cardiac output is lost, and complications such as cardiomyopathy and pericarditis emerge. Cardiomyopathy is when the muscles of the heart become weak due to a change in cellular structure. Pericarditis is the infection leading to inflammation of the protective sac like the envelope of the heart. This envelope is called the pericardium. Pediatric viral myocarditis can lead to death or permanent heart damage if left untreated in sporadic cases.

Conclusion

Pediatric viral myocarditis refers to the inflammation of the heart muscles due to an underlying viral infection. This is generally observed in the pediatric age group. The signs and symptoms are parallel to a viral infection as well as myocarditis (inflammation of the heart muscle). It has been reported after several studies that coronavirus too has been associated with pediatric viral myocarditis. The expansion of the muscles of the heart or the cardiac muscles leads to the malfunctioning of the heart. Thus diagnosis and treatment must be prompt, and there are several measures for the same respectively. After successful treatment, the patient is generally advised to keep at bay any kind of physical exertion or exercise and to take an ample amount of rest.