Myocarditis in modern pediatric practice


Ruzhentsova T.A.

Central Research Institute of Epidemiology, Russian Federal Service for Supervision of Consumer Protection and Human Welfare, Moscow, Russia
Myocarditis is one of the nosological entities that are difficult to diagnose in daily clinical practice, which can result in fatal outcomes if timely adequate therapeutic actions are not undertaken. Clinicians rarely diagnose this pathology, despite the fact that it is accompanied by myocardial inflammatory changes in 1 to 10% of cases of infectious diseases, according to investigators.
The paper presents basic information on myocarditis in children: classification, risk factors, etiology, pathogenesis, clinical picture, diagnosis, therapy and an algorithm for the management of patients in accordance with the current guidelines and the results of the authors’ investigations. Attention is drawn to the polymorphism of symptoms and the nonspecificity of detectable changes. Emphasis is laid on the high significance of electrocardiographic (ECG), ultrasound, and laboratory techniques that are available in a pediatrician’s daily practice. Probable myocarditis can be diagnosed based on the increased laboratory markers of myocardial damage, such as troponin, creatine kinase MB, and α-hydroxybutyrate dehydrogenase, as well as impairments detected by echocardiography. Etiotropic, metabolic, and symptomatic therapies are prescribed to patients.
Keywords: electrocardiography, creatine kinase MB, transaminases, myocarditis, troponin, echocardiography, children
Read entire article

Literature

  1. Tereshchenko S.N., Arutyunov G.P., Gilyarevsky S.R., Zhirov I.V., Zykov K.A., Masenko V.P., Narusov O.Yu., Nasonova S.N., Naumov V.G., Osmolovskaya Y.F., Samko A.N., Stukalova O.V., Sychev A.V., Sharia M.A. [Clinical Guidelines on diagnostics and treatment of myocarditis]. Evrazijskij kardiologicheskij zhurnal 2015; (3): 3–17. (In Russ.).
  2. Paleev N.R. [Myocarditis. In: Chazov E.I., ed. Heart disease and blood vessels. In 4 v. V. 2]. Moscow: Medicina, 1992; 178–98. (In Russ.).
  3. Baranov A.A., Namazova -Baranova L.S., Basargina E.N., Belozѐrov Yu. M., Degtуareva E.A., Balykova L.A., Kotlukova N.P., Sadykova D.I., Yakovleva L.V. [Federal clinical recommendations for the provision of medical care for children with myocarditis]. 2015. http://www.pediatr-russia.ru/sites/default/files/file/kr_mio.pdf (In Russ.).
  4. Ivkina S.S., Zaryankina A.I. [Non-rheumatic carditis in children]. Gomel: Gomel’skij Gosudarstvennyj Meditsinskij Universitet, 2012. 24 p. (In Russ.).
  5. Corvisart J.N. An essay on the organic diseases and lesions of the heart and great vessels. Transl. by J. Gates. Boston: Bradford and the Read, 1812; 299–303.
  6. Sobernheim J.F. Diagnostik der Inneren Krankheiten mit Vorzuegeleicher Ruecksicht auf Pathologische Anatomie. Berlin: Hirschwald; 1837: 1–43.
  7. Ruzhencova T.A., Ploskireva A.A., Shherbakov I.T., Isaeva E.I., Bondareva A.V., Gorelov A.V. [Myocardial lesions in Coxsackie A virus infection]. Fundamental’nye issledovanija 2015; 1(5): 1033–7. (In Russ.).
  8. Ruzhencova T.A., Ploskireva A.A., Shherbakov I.T., Tolordava Ye.R., Romanova Ju.M., Gorelov A.V., Milutina L.N., Chebyshev N.V. [Salmonella myocarditis in experimental conditions]. Uchenye zapiski. Byulleten’ akademii 2015; 2(7): 121–6. (In Russ.).
  9. Greaves К., Oxford J.S., Price C.P., Clarke G.H., Crake T. The prevalence of myocarditis and skeletal muscle injury during acute viral infection in adults: measurement of cardiac troponins I and T in 152 patients with acute influenza infection. Arch. Intern. Med. 2003; 163: 165–8. DOI: 10.1001/archinte.163.2.165.
  10. Finogeev Yu.P., Lobzin Yu.V., Volzhanin V.M., Semena A.V. [Heart disorders in infectious diseases]. St. Petersburg: Foliant, 2003. 251 p. (In Russ.).
  11. Paleev N.R., Paleev F.N., Sanina N.P., Makarkov A.I., Moskalec O.V., Ostrovskij E.I., Hishova N.N. [Heart failure at myocardites and a role of immune mechanisms in its development]. Russkij Medicinskij Zhurnal 2014; (12): 878–82. (In Russ.).
  12. Caforio A.L., Pankuweit S., Arbustini E., Basso C., Gimeno-Blanes J., Felix S.B., Fu M., Helio T., Heymans S., Jahns R., Klingel K., Linhart A., Maisch B., McKenna W., Mogensen J., Pinto Y.M., Ristic A., Schultheiss H.P. Current state of knowledge on aetiology, diagnosis, management and therapy of myocarditis. A position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur. Heart J. 2013; 34: 2636–48. DOI: 10.1093/eurheartj/eht210.
  13. D’Ambrosio A., Patti G., Manzoli A., Sinagrab G., Lenardab A.D., Silvestric F., Sciascio G.D. The fate of acute myocarditis between spontaneous improvement and evolution to dilated cardiomyopathy: a review. Heart 2001; 85(5): 499–504. DOI: 10.1136/heart.85.5.499.
  14. Dennert R., Crijns H.L., Heymans S. Acute viral myocarditis. Eur. Heart J. 2008; 29: 2073–82. DOI: 10.1093/eurheartj/ehn296.
  15. Giljarevskij S.R. [Myocarditis: modern approaches to diagnosis and treatment]. Мoscow: Меdia Sfera, 2008. 324 p. (In Russ.).
  16. Basso C., Calabrese F., Corrado D., Thiene G. Postmortem diagnosis in sudden cardiac death victims: macroscopic, microscopic and molecular findings. Cardivasc. Res. 2001; 50: 290–300. DOI:10.1016/s0008-6363(01)00261-9.
  17. Larsson E., Wesslen L., Lindquist O., Baandrur U., Eriksson L., Olsen E., Rolf C., Friman G. Sudden unexpected cardiac death among young Swedish orienteers-morphological changes in heart and other organs. APMIS 1999; 107(3): 325–36. DOI: 10.1111/ j.1699-0463.1999.tb01561.x
  18. Doolan A., Langlois N., Semsarian C. Causes of sudden cardiac death in young Australians. Med. J. Aust. 2004; 180: 110–2.
  19. Ruzhencova T.A. [Diagnosis and therapy of myocardial lesions in children with acute intestinal infections (clinical and experimental research)]. Dr. Med. Diss. Моscow, 2016. 47 p. (In Russ.).
  20. Shapchenko A.V., Arabidze G.G., Tebloev K.I., Muslimova O.V., Borisov V.G. [Myocarditis: classification, pathogenesis, clinic, diagnosis, treatment]. Terapevt 2011; (6): 50–65. (In Russ.).
  21. Wynne J., Baughman K.L. Myocarditis. In: Heart Disease. A Textbook of cardiovascular Medicine. Philadelphia, РА: Elsevier Saunders, 2005; 1697–718.
  22. Cioc A.M., Nuovo G.J. Histologic and in situ viral findings in the myocardium in cases of sudden, unexpected death. Mod Pathol. 2002; 5(9): 914–22. DOI: 10.1097/01.mp.0000024291.37651.cd.
  23. Lopatkina T.N., Strizhakov L.A., Konysheva A.A. Tanashhuk E.L., Taranova M.V., Moiseev S.V. [Heart disease in chronic hepatitis C]. Klinicheskaja farmakologija i terapija 2014; 23(4): 90–4. (In Russ.).
  24. Okabe M., Fukuda K., Arakawa K., Kikuchi M. Chronic variation of myocarditis associated with hepatitis C virus infection. Circulation 1997; 96: 22–4. DOI: 10.1161/01.cir.96.1.22.
  25. Cooper L.T. Myocarditis. N. Engl. J. Med. 2009; 360(15): 1526–38. DOI: 10.1056/nejmra0800028.
  26. Kovalenko V.N., Nesukaj E.G. Chernyuk S.V. [Myocarditis: a contemporary look on the etiology and pathogenesis of the disease.]. Ukrainskij kardiologicheskij zhurnal 2012; (2): 84–91. (In Russ.).
  27. Herskowitz A., Wu T.C., Willoughby S.B., Vlahov D., Ansari A.A., Beschorner W.E., Baughman K.L. Myocarditis and cardiotropic viral infection assotiated with severe left ventricular dysfunction in late-stage infection with human immunodeficiency virus. J. Am. Coll. Cardiol. 1994; 24: 1025–32. DOI: 10.1016/0735-1097(94)90865-6.
  28. Dunn J.J. Identification on the primary genomic determinants of cardiovirulence for clinical coxacievirus B3 isolate, 2000. 235 р.
  29. Poller W., Fechner E.L., Noutsias M., Tschoepe C., Pauschinger M., Schultheiss H.P. The molecular basis of cardiotropic viral infections. Eur. Heart J. 2002; 4(Suppl.1): 118–30. DOI: 10.1016/s1520-765x(02)90106-9.
  30. Xiao Nan, Zhang Junping. Function of antimyocardial antibody in the diagnosis of viral myocarditis. Shi jie Zhong Xi Yi. Jie He Za Zhi 2012; (7): 75–6.
  31. Martins V.P., Macedo A.J., Kaku S., Pinto F., Pinto E., Nunes M.A., Zarcos M.M., Nascimento M.C., Duarte L., Videira-Amaral J.M., Lima M. Acute myocardial infarct in infants. Acta Med Port. 1996; 9(10–12): 341–6.
  32. Mit’kovskaya N.P., Adamenko E.I., Il’ina T.V., Amvros’eva T.V., Poklonskaya N.V. [Myocarditis: current knowledge on etiology, diagnosis, management and therapy]. Kardiologiya v Belorusi 2015; 3(40): 113–36 (In Russ.).
  33. Matsumori A., Okada I., Yamada T., Maruyama S., Kawai C. Pathogenesis of myocardial injury in myocarditis and cardiomyopathy. Jpn. Circ. J. 1991; 55(11): 1132–7. DOI: 10.1253/jcj.55.1132.
  34. Mason J.W., Sanjeev T., Renlund D.G. Myocarditis. In: Willerson J.T., Wellens H.J.J., Cohn J.N., Holmes D.R. (eds). Cardiovascular Medicine. 3 ed. London: Springer, 2007; 1: 1313–47. DOI: 10.1007/978-1-84628-715-2_62 .
  35. Belozerov Yu.M. [Pediatric cardiology]. Мoscow: MEDpress-inform, 2004. 597 p. (In Russ.).
  36. Belokon’ N.A. [Non-rheumatic carditis in children]. Moscow: Medicina, 1984. 213 p. (In Russ.).
  37. Uhl T.L. Viral myocarditis in children. Crit Care Nurse. 2008; 28: 42–63.
  38. Friedman R.A., Schowengerdt K.O., Towbin J.A. Myocarditis. The Science and Practice of Pediatric Cardiology. Philadelphia, PA: Lippincott, 1999; 1777–94.
  39. Belenkov Yu.N., Oganov R.G. [Cardiology. National Guideline]. Moscow: GEOTAR-Media, 2008. 1290 p. (In Russ.).
  40. Mortensen S.A., Rosenfeldt F., Kumar A., Dolliner P., Filipiak K.J., Pella D., Alehagen U.,Steurer G., Littarru G.P. The Effect of Coenzyme on Morbidity and Mortality in Chronic Heart Failure Results From Q-SYMBIO: A Randomized Double-Blind Trial. J. Am. Coll. Cardiol.: Heart Failure 2014; (2): 641–9. DOI: 10.1016/j.jchf.2014.06.008.


About the Autors

For correspondence:
Tatiana A. Ruzhentsova, МD, Leading Researcher, Clinical Department of Infectious Pathology, Central Research Institute of Epidemiology, Russian Federal Service for Supervision of Consumer Rights Protection and Human Welfare
Address: 3a, Novogireevskaya St., Moscow 111123, Russia
Telephone: +7(495) 672-11-58
E-mail: ruzhencova@gmail.com.


Similar Articles

Back to Content

Бионика Медиа