The hosts discuss a critical case involving a one-month-old infant with respiratory distress and fever, linked to viral myocarditis. They explore the complexities of its diagnosis, symptoms, and management strategies in pediatric care. Key topics include the role of echocardiography, the significance of recognizing atypical symptoms, and various treatment options like IVIG and steroids. The conversation emphasizes the importance of a multidisciplinary team approach and the impact of timely intervention on outcomes.
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Infant Case Highlights Myocarditis
A one-month-old infant presented with poor feeding, respiratory distress, fever, and severe acidosis requiring immediate intubation.
The patient showed viral pneumonitis on chest X-ray, positive influenza test, elevated troponin, and abnormal echocardiogram indicating myocarditis.
insights INSIGHT
Myocarditis Causes and Genetics
Acute myocarditis often follows a viral illness, with genetic mutations increasing risk and poorer prognosis.
Infectious causes include adenovirus, enterovirus, influenza, and others; non-infectious causes include autoimmune and medication-related etiologies.
insights INSIGHT
Fulminant Myocarditis Severity
Fulminant myocarditis rapidly presents with hemodynamic compromise after a short viral prodrome.
It accounts for significant sudden cardiac death in children and may progress to dilated cardiomyopathy in 7% to 10% of cases.
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Textbook of Pediatric Critical Care Chapter 108. Life-threatening viral diseases and their treatment
Textbook of Pediatric Critical Care Chapter 108. Life-threatening viral diseases and their treatment
Intravenous immunoglobulin for presumed viral myocarditis in children and adults
S Vora
This chapter likely covers the diagnosis, management, and treatment of life-threatening viral diseases in pediatric patients. It may delve into specific viral infections and their impact on critical care. Key aspects could include clinical presentations, diagnostic approaches, and therapeutic interventions. The chapter aims to provide pediatric critical care professionals with essential knowledge and guidance. It emphasizes the importance of timely and effective management strategies for improving patient outcomes.
Rogers’ textbook of Pediatric Intensive Care. Chapter 74: cardiomyopathy, myocarditis, and mechanical circulatory support
Rogers’ textbook of Pediatric Intensive Care. Chapter 74: cardiomyopathy, myocarditis, and mechanical circulatory support
Chapter 74: cardiomyopathy, myocarditis, and mechanical circulatory support
WG Harmon
This chapter likely provides a detailed overview of cardiomyopathy, myocarditis, and mechanical circulatory support in pediatric intensive care. It may cover the etiology, pathophysiology, and clinical manifestations of these conditions. The chapter could also address diagnostic and therapeutic strategies, including the use of mechanical circulatory support devices. It aims to equip pediatric intensive care professionals with comprehensive knowledge and practical guidance. It emphasizes the importance of timely intervention and multidisciplinary collaboration for improving patient outcomes.
Today, Dr. Rahul Damania, Dr. Pradip Kamat, and Dr. Monica Gray, pediatric intensivists, sit down to chat about the diagnosis and management of acute myocarditis in children. They focus on a real-life case involving a one-month-old infant who presented with poor feeding, respiratory distress, and fever. Together, they break down the possible causes, key clinical signs, diagnostic approaches, and treatment options for pediatric myocarditis. Throughout the discussion, they highlight the importance of early recognition, a multidisciplinary team approach, and supportive care in improving outcomes for these critically ill infants. This episode is packed with practical insights and is designed to help pediatric intensivists tackle this challenging and potentially life-threatening condition. Tune in to hear more!
Show Highlights:
Definition and etiology of acute myocarditis in pediatric patients
Clinical case presentation of a one-month-old infant with acute myocarditis
Symptoms and clinical manifestations of acute myocarditis in children
Diagnostic approaches for identifying acute myocarditis, including echocardiography and laboratory tests
Management strategies for acute myocarditis, including intensive care and medication
Importance of recognizing atypical presentations in infants
Prognosis and risk factors associated with acute myocarditis
Role of multidisciplinary collaboration in managing acute myocarditis
Impact of viral infections on the development and severity of myocarditis
Outcomes and potential complications related to acute myocarditis in pediatric patients
References:
Fuhrman & Zimmerman - Textbook of Pediatric Critical Care Chapter 108. Life-threatening viral diseases and their treatment. Vora S et al. Pages 1273-1278
Rogers’ textbook of Pediatric Intensive Care. Chapter 74: cardiomyopathy, myocarditis, and mechanical circulatory support. Harmon WG et al. Pages 1247-1255
Robinson J, Hartling L, Vandermeer B, Sebastianski M, Klassen TP. Intravenous immunoglobulin for presumed viral myocarditis in children and adults. Cochrane Database Syst Rev. 2020 Aug 19;8(8): CD004370. Doi: 10.1002/14651858.CD004370.pub4. PMID: 32835416
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