1.What conditions arise that require taking my child to a cardiac specialty clinic?
You need to bring your child to the clinic if: (1) there is a family history of heart disease; (2) the child is found to have bruising, shortness of breath and feeding difficulties after birth; (3) the child has symptoms such as chest tightness, palpitations, weakness, shortness of breath, chest pain and syncope; (4) physical examination reveals heart murmur, arrhythmia, high blood pressure and enlarged heart.
2. What tests are needed when a child has heart disease?
According to the needs of the condition, chest X-ray, electrocardiogram, echocardiogram, cardiac enzyme profile, cardiac troponin, 24-hour ambulatory electrocardiogram (Holter) and other examinations are generally selectively performed, and cardiac MRI, exercise plate test, upright tilt test and other examinations are also required when necessary.
3.What is Holter and why do I need it?
Holter is “ambulatory electrocardiogram”, which is a recording device that is carried on the body to record the changes of ECG in the active and quiet state for 24 hours continuously. Because it is difficult to capture the abnormal ECG activity at one time, the ECG can detect the abnormalities such as arrhythmia and myocardial ischemia, which are not easily detected by conventional ECG, and is an important objective basis for clinical analysis, establishing diagnosis and judging the efficacy.
4. Why do we need ECG, cardiac ultrasound and Holter when myocardial enzymes are normal?
Myocardial enzyme spectrum is one of the indicators reflecting myocardial cell damage, and is generally used for the diagnosis of myocarditis and myocardial infarction. Some patients with heart diseases can have normal myocardial enzyme spectrum, such as congenital heart disease, arrhythmia, cardiomyopathy, etc. Therefore, ECG, cardiac ultrasound and Holter are needed to fully understand the presence of arrhythmia, abnormal heart structure, etc.
5.What is the cause of chest tightness, breath-holding, weakness and long breath in children?
If your child has the above symptoms, he/she needs to go to the cardiology department for a comprehensive assessment to rule out any heart disease or other systemic diseases such as myocardial damage, myocarditis, cardiomyopathy, etc. If various organic diseases are ruled out, it can be considered to be related to cardiac autonomic dysfunction.
6. What is myocardial damage?
Myocardial damage in pediatric patients refers to myocardial involvement from various causes and cannot be diagnosed clinically as myocarditis, cardiomyopathy, precordial disease, cardiac valve disease, etc., which are collectively referred to as myocardial damage, generally manifesting as myocardial enzyme profile and/or cardiac calprotectin abnormalities.
7. What is infectious myocarditis?
It refers to myocarditis resulting from infection by various pathogenic microorganisms. Heart enlargement, heart failure, cardiogenic shock or abnormal heart rhythm may occur during the course of the infection or during the recovery period. Viruses are the most common cause, and bacteria, rickettsiae, fungi, protozoa, and parasites are rare causative agents.
8. What is the difference between myocardial damage and myocarditis?
Myocardial damage is defined as damage at the myocardial level only in the presence of myocardial enzyme profile and/or troponin abnormalities, but not yet meeting the diagnostic criteria for myocarditis. Myocarditis in general has myocardial damage, but myocardial damage is not always myocarditis.
9. What are the common causes of myocarditis?
The most common cause of myocarditis is infectious myocarditis, of which viral infections are the most common (coxsackievirus, echovirus, adenovirus, hepatitis virus, etc.); bacteria (such as Corynebacterium diphtheriae, streptococcus, etc.), fungi, rickettsiae, spirochetes, protozoa, and parasites are rare causative factors. Other factors such as autoimmune diseases (e.g., acute rheumatic fever, Kawasaki disease, e.g., systemic lupus erythematosus), physical factors (e.g., myocardial damage caused by radiation therapy to the chest), and chemical factors (e.g., a variety of drugs such as some antimicrobials, oncologic chemotherapy drugs, etc.) can also cause myocarditis.
10. What are the manifestations of children with myocarditis?
Myocarditis is a common heart disease in children, with varying degrees of clinical manifestations. Small infants may have poor feeding, irritability, crying, drowsiness, nausea, vomiting, etc. Younger children may have lazy movement, long sighs, etc. Older children often complain of chest tightness, panic, dizziness, weakness, precordial pain or discomfort, etc.; in severe cases, convulsions may occur.
11. Why is myocarditis diagnosed despite normal cardiac enzymes?
There are four main diagnostic criteria for myocarditis, and myocardial enzyme profile is only one of them. Myocarditis can be diagnosed as long as two of the main diagnostic criteria are met. Even if myocardial enzymes are normal, myocarditis can be diagnosed as long as the other 2 major diagnostic criteria exist.
12.What are the causes of elevated cardiac enzymes in children? Is it myocarditis?
An elevated cardiac enzyme profile can be caused by or complicated by infection, arrhythmia, coronary artery disease, lack of oxygen, poisoning (drugs and toxins), metabolic disease, neuromuscular disease, and hematologic disease. Elevated myocardial enzymes are not necessarily indicative of myocarditis and should be evaluated with a thorough examination.
13. How to treat infectious myocarditis?
(1) general treatment: rest is recommended during the acute phase, restrict activities, exempt school-age children from physical activities, and avoid violent crying in infants and children; (2) anti-infective treatment: for children with the presence of infection, active symptomatic anti-infective (bacterial, viral, mycoplasma, etc.) treatment is required.
(2) anti-infection treatment: for children with infections, active symptomatic anti-infection (bacteria, viruses, mycoplasma, etc.) treatment is required. (3) Nutritional myocardial therapy: provide myocardial energy and promote myocardial cell repair, the course of treatment is usually 3-6 months. (4) For more severe conditions with congestive cardiac insufficiency, cardiogenic shock, cardiac
(4) In the case of severe cardiac insufficiency, cardiogenic shock, cardiac enlargement, severe arrhythmia (high or III degree AV block, ventricular tachycardia), diuretics, vasoactive drugs, positive inotropic drugs, hormones or gammaglobulin, etc. will be used according to the condition.
14. What are the things that children with myocarditis need to pay attention to in their daily life?
Children with myocarditis need to pay attention to rest, do not participate in sports activities to reduce the burden on the heart, and review regularly according to the doctor’s orders. The diet should be light, easy to digest and nutritious, with plenty of fresh vegetables and fruits.
15.Is myocarditis likely to occur repeatedly?
If the child has repeated infections, there is a possibility of recurrence of myocarditis.
16.How long do I need to take heart muscle preservation drugs?
Myocardium-nourishing drugs can provide myocardial energy and promote myocardial cell repair, and are usually taken orally for 3-6 months.
17.When can children with myocarditis take physical education classes?
The ability to exercise after myocarditis is determined by the severity of the child’s condition. In the acute phase of myocarditis, physical activity should be limited, although prolonged bed rest should be avoided. Patients with mild myocarditis can generally participate in 10-30 minutes of aerobic exercise, such as walking, 3-4 weeks after the onset of the disease. After 3 months of exercise, increase the amount of activity, such as swimming, bicycling and gymnastics, according to the follow-up, but be sure to pay attention to gradual progress. Those who have heart failure or enlarged heart should rest for 6 months-1 year, or until the heart size returns to normal and blood sedimentation is normal, and then start activity according to the follow-up results of ECG, heart ultrasound, Hoter and exercise test to decide the amount of activity.
18.How to prevent myocarditis?
You should have a balanced diet, pay attention to exercise, enhance physical fitness, take rest and avoid colds. Once a cold occurs, you should rest more and seek medical advice promptly if you experience chest tightness, weakness and other discomforts.
19.Why do children get Kawasaki disease?
It is believed that Kawasaki disease may be an immune disease caused by one or more pathogenic microorganisms entering the body, and is related to abnormalities in the immune system caused by infection, and genetic susceptibility exists in some affected children.
20.Does Kawasaki disease recur?
Kawasaki disease has a recurrence rate of about 2-3%, mostly within 2 years of the initial onset, and is generally related to the immune status of the child.
21.What do I need to pay attention to after discharge from the hospital for Kawasaki disease?
After discharge from the hospital, follow-up examinations will be conducted once a year for 1 month, 2 months, 3 months, 6 months, 1 year and 5 years after the onset of the disease, including cardiac ultrasound, electrocardiogram, platelets and blood sedimentation if necessary. For children without coronary artery dilation or with transient mild coronary artery dilation during hospitalization, oral low-dose aspirin is recommended for 6-8 weeks; for children with significant coronary artery dilation, the course of aspirin and the amount of exercise are determined according to the degree of coronary artery dilation, with long-term follow-up. Immunizations are generally not received within 6 months of onset due to the use of gammaglobulin.
22. If a child with Kawasaki disease has no coronary artery dilation during hospitalization, will the coronary artery still be dilated after discharge?
If a child with Kawasaki disease does not have dilated coronary arteries during hospitalization, and there are no significant abnormalities in various inflammatory indexes such as blood sedimentation and CRP on review, it is generally less likely that coronary artery dilatation will occur after discharge from the hospital.