Abstract

Objectives: Acute myopericardial syndromes (myopericarditis and perimyocarditis) are most challenging diseases to diagnose and treat in pediatric cardiology. The true incidences of the diseases are unknown because the disease can be subclinical or mild enough to go unrecognized in the context of a viral syndrome. The clinical manifestations of acute myopericardial syndromes vary widely from typical chest pain and changes on electrocardiogram to atypical chest pain, non-specified electrocardiography changes and subclinical left ventricular dysfunction. The aim of this study is to help pediatricians to the evaluation and management of these common and complex clinical syndromes.

Material and Methods: The patients who were diagnosed with myopericarditis or perimyocarditis at Dr. Sami Ulus Maternity, Children's Health and Diseases Training and Research Hospital between 2010-2019 were retrospectively evaluated. Patients who had fulminant form of myocarditis or progressing to dilated cardiomyopathy were excluded from the study. The medical records of the patients were examined and age, gender, diagnostic tests and diagnosis were evaluated.

Results: During the study period, records of 260 patients were reached, 47 patients were excluded from the study because of fulminant myocarditis and progression to dilated cardiomyopathy. Of the remaining 213 patients, 68% were male, 32% were female and the median age was 156 months (32 to 212 months). Patients diagnosed with perimyocarditis and myopericarditis were admitted with the complaint of chest pain, and the diagnosis was made by history, physical examination, electrocardiography and echocardiography findings.

Conclusions: Pediatricians should be aware of the clinical signs and symptoms that should increase the index of suspicion for acute myopericardial syndromes because prompt referral to the emergency department, with access to specialists with expertise in the care and support of these patients, is imperative.

Keywords: pericarditis, myocarditis, children

References

  1. 1. Magnani JW, Dec GW. Myocarditis: current trends in diagnosis and treatment. Circulation. 2006; 113:876–890.
  2. 2. Imazio M, Gaita F. Diagnosis and treatment of pericarditis. Heart 2015;101:1159–1168.
  3. 3. Imazio M, Trinchero R. Myopericarditis: etiology, management, and prognosis. Int J Cardiol 2008; 127(1):17–26.
  4. 4. Imazio M. Contemporary management of pericardial diseases. Curr Opin Cardiol 2012;27:308–317.
  5. 5. Imazio M, Spodick DH, Brucato A, Trinchero R, Adler Y. Controversial issues in the management of pericardial diseases. Circulation 2010;121:916–928.
  6. 6. Imazio M, Cecchi E, Demichelis B, Chinaglia A, Ierna S, Demarie D, Ghisio A, Pomari F, Belli R, Trinchero R. Myopericarditis versus viral or idiopathic acute pericarditis. Heart 2008;94:498–501.
  7. 7. Imazio M, Brucato A, Barbieri A, Ferroni F, Maestroni S, Ligabue G, Chinaglia A, Cumetti D, Della Casa G, Bonomi F, Mantovani F, Di Corato P, Lugli R, Faletti R, Leuzzi S, Bonamini R, Modena MG, Belli R. Good prognosis for pericarditis with and without myocardial involvement: results from a multicenter, prospective cohort study. Circulation 2013;128:42–49.
  8. 8. Imazio M, Cooper LT. Management of myopericarditis. Expert Rev Cardiovasc Ther 2013;11:193–201.
  9. 9. Hoit BD. Pathophysiology of the pericardium. Prog Cardiovasc Dis 2017;59(4):341–8.
  10. 10. Tonini M, Pessoa de Melo DT, Fernandes F. Acute pericarditis. Rev AssocMed Bras 2015; 61(2):184-190
  11. 11. Tunuguntla H, Jeewa A, Denfield SW Acute Myocarditis and Pericarditis in Children. Pediatr Rev. 2019 Jan;40(1):14-25.
  12. 12. Farzad A, Schussler JM. Acute Myopericardial Syndromes Cardiol Clin 36. 2018; 103–114.
  13. 13. Adler Y, Charron P, Imazio M, et al. 2015 ESC guidelines for the diagnosis and management of pericardial diseases: the Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC) endorsed by: the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2015;36(42):2921–64.
  14. 14. Wang K, Asinger RW, Marriott HJL. ST-segment elevation in conditions other than acute myocardial infarction. N Engl J Med 2003;349(22):2128–35.
  15. 15. Brady WJ, Syverud SA, Beagle C, et al. Electrocardiographic ST-segment elevation: the diagnosis of acute myocardial infarction by morphologic analysis of the ST segment. Acad Emerg Med. 2001; 8(10):961–7.
  16. 16. Bischof JE, Worrall C, Thompson P, et al. ST depression in lead aVL differentiates inferior ST-elevation myocardial infarction from pericarditis. Am J Emerg Med 2016;34(2):149–54
  17. 17. Lotrionte M, Biondi-Zoccai G, Imazio M et al. International collaborative systematic review of controlled clinical trials on pharmacologic treatments for acute pericarditis and its recurrences. Am. Heart J. 2010: 160(4), 662–670.
  18. 18. Imazio M, Adler Y. Treatment with aspirin, NSAID, corticosteroids, and colchicine in acute and recurrent pericarditis. Heart Fail. Rev.2013: 18(3), 355–360.
  19. 19. Costanzo-Nordin MR, Reap EA, O'Connell JB, Robinson JA, Scanlon PJ. A nonsteroidal antiinflammatory drug exacerbates coxsackievirus B3 murine myocarditis. J Am Coll Cardiol 1985;6:1078–82.
  20. 20. Rezkalla S, Khatib G, Khatib R. Coxsackievirus B3 murine myocarditis. Deleterious effects of non-steroidal anti-inflammatory agents. J Lab Clin Med 1986;107:393–5.

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How to cite

1.
Yoldas T, Örün U. The Diagnostic and Clinical Approach to Acute Myopericardial Syndromes in Children and Adolescent. Turk J Pediatr Dis [Internet]. 2020 Sep. 29 [cited 2025 May 25];14(5):402-7. Available from: https://turkjpediatrdis.org/article/view/660