Exploring a Complex Pediatric Myopericarditis Case

Contributor: Meghan Hurley MD

Educational Pearls:

• Pericarditis is inflammation of the pericardial sac, which can arise from infectious or non-infectious etiologies

• Myocarditis is inflammation of the myocardium, which may accompany pericarditis

• Pericarditis clinical findings include:

• Diffuse concave ST elevation, classic for acute pericarditis with myocardial involvement. More common in younger male patients

• Elevated high-sensitivity troponin - higher levels may occur in young healthy patients

• Ultrasound may show pericardial effusions

• POCUS may be helpful in assessing left ventricular ejection fraction (LVEF) via E-point septal separation (EPSS)

• Elevation in EPSS correlates with decreased LVEF

• Treatments:

• Anti-inflammatories including NSAIDs and colchicine

• Monitor inflammation

• Repeat ultrasounds

• Risk factors in this patient's case:

• mRNA COVID vaccine - the risk of myocarditis from vaccination is significantly lower than that from COVID-19 infection

• Preceding infection

References

1. Gao J, Feng L, Li Y, et al. A Systematic Review and Meta-analysis of the Association Between SARS-CoV-2 Vaccination and Myocarditis or Pericarditis. Am J Prev Med. 2023;64(2):275-284.

2. Imazio M, Gaita F, LeWinter M. Evaluation and treatment of pericarditis: A systematic review. JAMA - J Am Med Assoc. 2015;314(14):1498-1506. doi:10.1001/jama.2015.12763

3. Mckaigney CJ, Krantz MJ, La Rocque CL, Hurst ND, Buchanan MS, Kendall JL. E-point septal separation: A bedside tool for emergency physician assessment of left ventricular ejection fraction. Am J Emerg Med. 2014;32(6):493-497. doi:10.1016/j.ajem.2014.01.045

Summarized by Jorge Chalit, OMSII | Edited by Meg Joyce & Jorge Chalit, OMSII