BACKGROUND AND AIMS:
to determine,the frequency of various presenting symptoms and the sensitivity of clinical and laboratory investigations routinely available in children with myocarditis.
METHODS:
We performed a retrospective review of all patients < 16 years who were diagnosed as having myocarditis between September 2004 and September 2007 and who initially presented to an emergency department. Patients were categorized as having definite myocarditis (positive cardiac enzymes results) or probable myocarditis (diagnosis assigned by a pediatric cardiologist on the basis of history, physical examination).
RESULTS:
There were 11 cases of definite myocarditis and 10 cases of probable myocarditis. The age distribution was abnormal, with peaks among children < or = 3 years and > or = 16 years of age. Of 12 patients who were seen by a physician before being diagnosed with myocarditis, 65% were originally diagnosed as having pneumonia or asthma. 29% had cardiac symptoms, and 6% had gastrointestinal symptoms. Although evidence of cardiac dysfunction was frequently present in the form of respiratory distress, only a minority of children had evidence of hepatomegaly or abnormal cardiac examination results. The sensitivities of electrocardiograms and chest radiographs as screening tests were 90% and 52%, respectively. Among laboratory tests studied,CK-MB measurement was the most sensitive (sensitivity: 85%).
CONCLUSIONS:
Children with myocarditis present with symptoms that can be mistaken for other types of illnesses; respiratory presentations were most common. When clinical suspicion of myocarditis exists,All children should undergo CXR ,electrocardiography as screening test. CK-MB testing may be a useful adjunctive investigation.