Myocarditis
The vague symptoms these patients present with make this a difficult to diagnose condition in the emergency room and a high clinical suspicion must be maintained.- Erik Handberg, MD
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HWN Suggests
Menacing Muscle: Acute myocarditis in adults
Myocarditis is inflammation of cardiac muscle caused by a variety of conditions. It has a variable presentation, ranging from acute to chronic inflammation, with focal to diffuse myocardial involvement. It has been recognized as a frequent cause of sudden cardiac death, up to 20% in young adults. It is commonly quoted that myocarditis is the most common cause of acute heart failure in patients <40 years old.
Despite these frightening facts, it remains an elusive diagnosis, especially in children. This is likely because most cases are mild, resolve without sequelae, and those patients do not seek medical attention. In 2013, there were an estimated 22 per 100,000 cases worldwide. This…
Articles of Interest
Myocarditis in Adults: ED Presentations, Evaluation, and Management
he nature of chest pain with myocarditis is widely variable, ranging from pleuritic to anginal chest pain. Patients may present anywhere along the spectrum of congestive heart failure with symptoms from fatigue and peripheral edema to outright cardiovascular collapse.
Myocarditis in the ED
While relatively uncommon, especially compared with other causes of chest pain such as acute coronary syndrome, complications of myocarditis are presumed to cause 20% of cases of sudden death in young adults and it is a leading cause of dilated cardiomyopathy worldwide. In the pediatric population, undiagnosed myocarditis is one of the common diagnoses involved in emergency department malpractice claims.
Resources
emDOCs
Initial diagnosis is often delayed due to wide range of non-specific symptoms. Misdiagnosis is common and often includes asthma, pneumonia, URI, or gastroenteritis in pediatric patients.
LITFL
Paradoxically the more fulminant -> the better the prognosis.
Pediatric EM Morsels
Studies have consistently shown that younger children do not typically present with “cardiac” symptoms. Adolescents may present with more chest pain complaints similar to adults.
