Pediatric myocarditis often caused by viruses

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Childhood myocarditis is most commonly caused by a viral infection, although there are several infectious and non-infectious causes, according to a scientific statement from the American Heart Association.

Although work on the statement began before the COVID-19 pandemic, it may be helpful in diagnosing myocarditis caused by COVID-19 infection or by COVID-19 vaccination, the AHA said in a press release.

Myocarditis in children is usually caused by a viral infection, although there are several infectious and non-infectious causes. Data is derived from Law YM, et al. Circulation. 2021;doi:10.1161/CIR.0000000000001001.

‘Potential impact on lifelong health’

“Myocarditis has distinct characteristics in children and a potential impact on their lifelong health,” Yuk M. Law, MD, FAHA, chair of the statement-writing scientific group, director of Cardiac Transplant and Heart Failure Service at Seattle Children’s Hospital and professor of pediatrics at the University of Washington School of Medicine in Seattle, said in the release. “We hope this statement serves as an educational update and as a unifying call for much-needed research to better understand and treat this important pediatric condition. And in light of the recently recognized occurrence of myocarditis following COVID-19 infection, as well as With the emergence of cases of suspected myocarditis following COVID-19 vaccination, this statement is a resource for clinicians and healthcare professionals in caring for these patients.”

The incidence of myocarditis is highest in infants and young adults, Law and colleagues wrote, noting that in children it is usually caused by a viral infection and usually starts acutely or suddenly, and is less likely to be chronic than in adults.

The writing group recommended that when active inflammation from myocarditis is present, a child or adolescent should not participate in competitive sports, and should have 24-hour Holter monitoring and exercise testing at least 3 months after diagnosis and before returning. to competition.

The most common symptoms of myocarditis in children are fatigue, shortness of breath, abdominal pain and fever, Law and colleagues wrote, noting that severe symptoms such as HF, arrhythmias and cardiogenic shock sometimes occur. According to the release, the most common symptom of myocarditis caused by a COVID-19 vaccine is chest pain.

None of the most common symptoms are specific to myocarditis and may result from other causes, the authors wrote.

Children with acute myocarditis can deteriorate rapidly, so it may be reasonable to monitor them in a hospital setting, the authors said. Patients should be monitored for arrhythmias at an early stage. In addition, high-risk patients may benefit from mechanical circulatory support as myocardial injury can occur, Law and colleagues wrote.

IV immunoglobin and corticosteroids are among the common treatments for pediatric myocarditis, but more evidence is needed to determine the optimal treatment regimens, the authors said. They also wrote that antiviral therapy may be considered if the cause of the myocarditis is viral.

Myocarditis can also result from Kawasaki disease or rheumatic fever, in which case guidelines for managing those diseases should be followed, Law and colleagues wrote.

COVID-19 vaccination encouraged

In the release, the AHA and American Stroke Association stated that it “recommends that all healthcare professionals be aware of rare side effects that may be associated with a COVID-19 vaccine, including myocarditis. Healthcare professionals should strongly consider inquiring, if necessary, about the timing of a recent COVID vaccination in patients with symptoms related to cardiovascular disease, in order to confirm the diagnosis and provide appropriate treatment promptly. As stated by the CDC, we agree that cardiologists should be consulted if myocarditis or a heart-related condition is suspected by a primary care physician.

“This new scientific statement provides a thorough review of the latest research on the diagnosis, treatment and follow-up of childhood myocarditis prior to the COVID-19 era and confirms that myocarditis is a serious but uncommon condition in children. The effects of COVID-19 infection include the potentially fatal consequences and the potential long-term health effects that are still emerging, such as diseases of the heart, including myocarditis, the brain, the vascular system and other organs.

“We remain steadfast in our recommendation for all adults and children ages 12 and older in the U.S. to get a COVID-19 vaccine as soon as they can get it, as approved by the FDA and recommended by the CDC. Overwhelmingly, data continues to indicate that the benefits of COVID-19 vaccination — 91% effective in preventing complications of severe COVID-19 infection, including hospitalization and death — far outweigh the very rare risks of side effects, including myocarditis.”

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