Etiology: The most common viruses are “coxsackie” enterovirus, adenovirus and echovirus. Viruses cause damage to the heart in two ways: one is that they enter the body and reach the heart with the bloodstream, directly entering the myocardial cells and damaging them; the other is that they induce the body to produce substances that harm the myocardial cells, causing them to be damaged. The former is often seen in the early and acute stages of the disease, while the latter is mostly seen in the late and chronic stages.
There are three common ways of starting viral myocarditis, namely general, fulminant and insidious. The generalized form often starts with a history of respiratory or intestinal infections, such as colds and diarrhea, 1-2 weeks prior to the onset of the disease, followed by symptoms such as stuffiness, shortness of breath, weakness, and pallor. The onset of fulminant symptoms is often without any aura or signs, and the onset of fulminant symptoms is often characterized by a sudden onset of stroke, which is medically known as “As syndrome”.
The fulminant form can also be characterized by sudden heart failure with a sudden drop in blood pressure and cardiogenic shock. The insidious type has an insidious onset sink without an obvious history of precursor respiratory and intestinal infections, often presenting with discomfort after exertion, and only when the patient goes to the hospital for examination are enlarged hearts and reduced cardiac function found. The most common clinical mode of onset is the general type, but the fulminant and insidious types pose the greatest threat to the child and should be taken seriously by parents and clinicians.
The diagnosis of myocarditis can be made with the help of electrocardiogram and blood biochemical tests, in addition to the above mentioned manifestations. The presence of myocarditis should be considered when there is a new manifestation of arrhythmia on the electrocardiogram. However, it is important to note that the diagnosis of viral myocarditis should never be based on arrhythmias on the ECG alone, otherwise some simple arrhythmias may be misdiagnosed as viral myocarditis. The most common indicators of blood biochemistry are myocardial enzyme profile and cardiac troponin.
It should be emphasized that the normal values of myocardial enzyme profiles used in many hospitals are adult standards, while in fact the normal values of myocardial enzyme profiles in pediatric patients are higher than the normal adult values. The test has been proven to improve the accuracy of the diagnosis of viral myocarditis. For some complex cases, more advanced and expensive testing instruments and tools may be required. Endomyocardial biopsy is required to clarify the diagnosis if necessary.
What should parents pay attention to in children with viral myocarditis? First of all, do not create excessive mental stress, but make the child build confidence to overcome the disease. Secondly, the child should rest in bed as much as possible, eat easily digestible food, and eat more fruits. Third, actively cooperate with the doctor for treatment.
Generally, treatment in hospital lasts about 3 weeks, and then you can treat at home. Because of the special nature of the virus damage to the heart, the recovery period is longer than the virus damage to other organs, usually 3 months to 6 months. Some children will insist on going to school during this period because they do not want to delay their classes, but they should be careful not to overexert themselves, limit their physical activity appropriately, and have regular follow-ups at the hospital.
Pediatric myocarditis diagnosis and treatment.
There are more than 20 viruses known to cause myocarditis in children. These viruses enter the bloodstream and invade the heart muscle directly, while causing the body to produce some substances that damage the heart muscle and cause myocarditis. When a child develops shortness of breath, chest tightness and pallor soon after a cold, he should go to the hospital for a detailed examination.
First of all, an electrocardiogram should be done. If any arrhythmia or significant abnormality of T wave is found, it is meaningful for diagnosis in combination with clinical. Such as cardiac enzyme profile and cardiac troponin measurement. Echocardiography may be performed in children with more severe myocarditis to detect enlargement of the heart chambers and any decrease in cardiac function. In children with complex disease, myocardial and endomyocardial biopsies may be required to confirm the diagnosis if necessary.
With timely diagnosis and treatment, most children with toxic myocarditis can be cured without affecting their future health. However, if treatment is not timely or if the bottom is not removed, the disease will often relapse and even develop into delayed myocarditis or cardiomyopathy, which will then be very difficult to restore to normal and will affect the growth and development of the child.
Diarrhea is a common pediatric disease, and many diarrheas are caused by viruses, some of which can invade the heart and cause viral myocarditis. Pediatric myocarditis has three general manifestations.
Premature beats are one of the manifestations of viral myocardium. Most children have no discomfort and an electrocardiogram is performed before being confirmed. If the child is well, the heart is not enlarged and the heart functions normally, medication can be temporarily disregarded and the premature beats will slowly decrease and disappear, but attention must be paid to the child’s rest and nutrition.
Heart block is a virus that damages the conduction system of the heart so that the excitation of the heart to start beating is not transmitted properly in different parts of the heart. In mild cases, there may be no manifestations and only an electrocardiogram is performed to detect it; in severe cases, the heartbeat rhythm becomes slow or irregular. If the number of heartbeats per minute is less than 40, the child may suffer from cerebral ischemia, causing generalized convulsions and even sudden cardiac arrest. This type of critical myocarditis requires emergency hospitalization.
Heart failure is a sign of severe myocarditis. The child has an enlarged heart and reduced myocardial contractility, which prevents the heart from effectively acting as a blood pump, thus preventing the systemic tissue from being supplied with oxygen to meet normal needs. At this time, the child may have symptoms such as shortness of breath, pale face, rapid heartbeat, weak pulse, and inability to lie down. If not treated in time, the child’s life can be endangered.
There is no effective treatment for viral myocarditis. Generally, comprehensive treatment measures are taken.
1, bed rest to reduce the burden on the heart and reduce oxygen consumption. The enlarged heart and complications of heart failure should be extended bed rest for at least 3 to 6 months, and then gradually active after the condition improves or the heart shrinks.
2, sedation and analgesic treatment patient agitation, precordial pain, abdominal pain guinea pig myalgia, must be timely symptomatic treatment, the use of analgesic analgesics, such as phenobarbital, aspirin, somatostatin, codeine, if necessary, can be injected morphine.
3, immunosuppressants are used to rescue the acute phase of concurrent cardiogenic shock, complete atrioventricular block and heart failure by other treatment is not satisfactory, generally should not be routinely used in early myocarditis. Start with hydrocortisone 5-10mg/(kg・d) or dexamethasone 0.25-0.5mg/(kg・d), intravenously. Later, prednisone 1~2mg/(kg・d) is given orally, and the dosage is gradually reduced after 1 month, and azathioprine 2mg/(kg・d) is added orally for more than 6 months, and attention is paid to the prevention and treatment of secondary infections. Thirteen cases of severe infantile and pediatric myocarditis confirmed by myocardial biopsy were reported, all of which were treated with prednisone and one case with azathioprine.
4, other treatment Vitamin C has the effect of eliminating free radicals, 100-200mg/(kg・d) add glucose solution 20-50ml intravenous injection, 3-4 weeks for a course of treatment. Coenzyme Q10 has a protective effect on the myocardium, inject 5mg intranasally daily for 2-3 weeks, and 1,6-diphosphate fructose can improve myocardial metabolism, inject 100-250mg/kg intravenously daily for 2-3 weeks. Astragalus has antiviral and cardioprotective effects, can be longer-term oral or inotropic injection.
5, symptomatic treatment Complicated arrhythmia, cardiogenic shock, heart failure treatment.