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Abstract: A 5-year-old child came to the hospital because he was exercising rather vigorously in an activity class and suddenly sat down paralyzed, pale, and had difficulty breathing. The child reported that he was weak, felt tightness in the chest, and had difficulty breathing. Subsequent examination and auscultation revealed a rapid heart rate and slightly rapid breathing. Combined with the ECG, cardiac ultrasound and myocardial enzyme profile report, a diagnosis of pediatric myocarditis was made. After about 7 days of cardiac monitoring with intravenous fluid treatment, the child’s symptoms were relieved.
Basic information】Male, 5 years old
Disease Type】Mild pediatric myocarditis
Hospital】Shanghai Sixth People’s Hospital
Date of Consultation】July 2021
Treatment plan] Cardiac monitoring + medication (adenosine triphosphate disodium magnesium chloride injection + coenzyme Q10 injection + vitamin C injection)
Treatment Period】Hospitalization for 7 days, rechecked after 1 week
Treatment effect】The child’s condition returned to normal
I. Initial consultation
One evening, a mother brought her 5-year-old boy to the hospital, stating that her child had caught a cold two days before and was sneezing, having a runny nose and feverish symptoms. Today, the child was moving vigorously in the kindergarten, and then suddenly sat down, pale, with difficulty in breathing, and the child said he felt chest tightness and lack of strength. He then listened to his heart rate, which was slightly faster at 110 beats/min, with strong heart sounds, a respiratory rate of about 25 breaths/min, blood pressure of 90/60 mmHg, oxygen saturation of 93%, warm extremities, pulsation, and a normal mental response. He was given electrocardiogram, cardiac ultrasound, blood count, arterial blood gas, electrolytes, and cardiac enzyme profile. In the electrocardiogram, the PR interval was slightly prolonged and the ST segment was slightly depressed. The ejection fraction was normal in the cardiac ultrasound, but a congenital ventricular septal defect of 5 mm was found. The mother said she had never had a heart ultrasound before, so she was unaware of this condition. The creatine kinase isoenzyme in the cardiac enzyme profile was elevated to 49 U/L, and the diagnosis of mild pediatric myocarditis was considered.
II. Treatment
The child was admitted to the hospital, given electrocardiographic monitoring, 24-hour in and out volume, strict bed rest, reduced activity, and intravenous infusion of adenosine triphosphate disodium magnesium chloride injection, coenzyme Q10 injection, vitamin C injection and other drugs to nourish the myocardium, and the child was instructed to stay calm and avoid strenuous activities and emotional ups and downs. After about 7 days of hospitalization, the child’s symptoms were relieved and he was discharged from the hospital, and his parents were instructed to bring him for a review in 1 week.
Treatment effect
After 7 days of hospitalization, the child’s symptoms of dyspnea were significantly improved, his complexion was rosy, and his fatigue was relieved. However, since the child has a ventricular septal defect, it is recommended to follow up with the pediatric cardiology department and perform interventional blocking if necessary.
IV. Notes
We are glad that the child’s symptoms have improved, but we still need to advise the child and parents to avoid strain, heavy physical labor, and prolonged strenuous activities in daily study and life, to maintain emotional stability, to avoid emotional ups and downs, and to pay attention to a balanced diet and to strengthen nutrition. In addition, some children have congenital arrhythmias or structural defects of the heart, which are unknown until they are examined, so it is necessary to improve the relevant tests if necessary.
V. Personal insight
Myocarditis at a young age is very dangerous once serious illness occurs, so in any illness, pay special attention to the child’s mental status to check for chest tightness and weakness and changes in face color. Once any of these symptoms manifest, prompt medical attention is needed. Cardiac tests, including electrocardiogram, myocardial enzyme profile and cardiac ultrasound, should not be omitted during the examination. For children who have had myocarditis, it is also important to pay attention when they have a cold or fever, and it is especially important to wait until the child is completely well before going to school. Avoid sudden onset of pediatric myocarditis like the child in this case.