Download to read offline
Uploaded byDr. Nagendra Chaudhary
Pericarditis and myocarditis in children.pptx
Lecture notes on Pericarditis and Myocarditis in children
More Related Content
Similar to Pericarditis and myocarditis in children.pptx
Pericarditis and myocarditis in children.pptx
- 1. Pericarditis and Myocarditis Dr.Nagendra Chaudhary MD Pediatrics (AIIMS, New Delhi) Professor and Head Department of Pediatrics, UCMS-TH
- 2.
- 3. Introduction Pericardium Fibro-elastic sac Visceral and parietal layers Separated by a space called pericardial cavity
- 4. Diseases of thepericardium • Acute and recurrent pericarditis • Pericardial effusion • Cardiac tamponade • Constrictive pericarditis
- 5. Definition Acute pericarditis refersto inflammation of the pericardial sac
- 6. Etiology A. Idiopathic • Presumedto be viral, post viral, or immune mediated • Majority of patients are not found to have an identifiable cause
- 7. Etiology B. Infectious causes •Viral (common): Coxsackie virus, coronavirus, influenza, herpes viruses, varicella, mumps, rubella, parvovirus B19, HIV • Bacterial: Mycobacterium tuberculosis • Fungal (very rare): Aspergillus, Candida, Histoplasma • Parasitic (very rare): Toxoplasma, Echinococcus, Trypanosoma cruzi
- 8. Etiology C. Non-infectious causes •Autoimmune (common): SLE, rheumatoid arthritis, scleroderma, MCTD • Neoplastic: Pericardial tumors • Metabolic: Uremia • Trauma • Drugs- Penicillin, isoniazid, methyl dopa • Radiation
- 9. Common etiology Viral inorigin in developed countries whereas in developing world Tuberculosis is the most frequent etiology
- 10.
- 11. Clinical features • Chestpain and/or dyspnea : Sharp and pleuritic, worsened when supine and improved by sitting up and leaning forward • Pericardial friction rub: Superficial scratchy or squeaking sound • ECG changes: New widespread ST elevation and PR depression • Pericardial effusion: Common feature of pericarditis Presence of at least 2 of the above 4 criteria
- 12. Clinical features Non specificsymptoms • Infectious etiology- fever and leukocytosis • Viral etiologies- flu-like" respiratory or gastrointestinal symptoms • Autoimmune disorder or malignancy may present with signs or symptoms specific to their underlying disorder
- 13. Clinical signs • Pericardialfriction rub • Tachycardia • Signs of pericardial effusion – Muffled heart sounds – Hypotension – Raised JVP if tamponade
- 14. Investigations Echocardiography • Can benormal • Detects pericardial effusion Chest X-ray • Can be normal • Detects pericardial effusion Cardiac biomarkers • May be associated with in serum biomarkers of myocardial injury (Troponin I or T)
- 15. Investigations Signs of inflammation •Increase in WBC count, ESR and CRP Cardiac MR and/or CT • thickness of the pericardium Pericardiocentesis and pericardial biopsy
- 16. ECG changes inPericarditis Up-sloping (concave up) ST-segment elevations in leads II, III, aVF, and V2 to V6
- 17. Management Hospital admission Urgent pericardiocentesis •for cardiac tamponade Drugs • NSAIDs- Ibuprofen • Colchicine • Steroids • Antibiotics/anti-TB drugs Dialysis • for uremic patients
- 18.
- 19. Definition Acute myocarditis • Inflammationof the heart muscle (myocardium) leading to myocardial injury, necrosis and impaired contractility • Incidence- 0.2 to 2 cases per 100,000; aged <18 years
- 20. Pathogenesis • Myocardial inflammation,necrosis and fibrosis • Myocardial damage leading to decreased systolic function and cardiomegaly • Features of shock and hyoptension leading to death
- 21. Etiology A. Infectious • Viral(most common)- Coxsackie B, Adenovirus, Influenza, Parvovirus B19, SARS-CoV-2 • Bacterial: Diptheria, mycoplasma. Lyme disease • Protozoal- Trypanosoma cruzi (chagas disease) • Fungal- Candida (rare)
- 22. Etiology B. Non-infectious • Autoimmune-SLE, Kawasaki disease • Hypersensitivity/drug induced • Toxins- alcohol • Post vaccination (rare)
- 23. Clinical features • Variable •May range from subclinical disease to Cardiogenic shock, arrhythmias, and sudden death
- 24. Clinical features Symptoms • Viralprodrome- fever, malaise, sore throat, body ache • Dyspnea- on exertion • Palpitation • Chest pain • Syncope
- 25. Clinical features Signs • Tachycardia •Signs of heart failure- tachypnea, fine crepts, S3 gallop, hepatomegaly, peripheral edema • Arrhythmia • Hypotension • Shock
- 26. Fulminant myocarditis • Mostsevere form of myocarditis • Leads to sudden and severe myocardial inflammation, myocyte necrosis, edema, and Cardiogenic shock • May cause death in 68.8 % of affected children within 7 days of hospital admission
- 27. Investigations • ECG: sinustachycardia, ST-T changes, conduction blocks • Chest x-ray: Cardiomegaly, pulmonary congestion • Echocardiography: Dilated ventricles, global hypokinesia, reduced ejection fraction
- 28. Investigations • Cardiac enzymes-Increased Troponin and CK- MB • Blood tests- Increased CRP, ESR, TLC • Cardiac MRI- myocardial edema • Endomyocardial biopsy (gold standard)
- 29. Diagnostic clues Recent viralillness + New onset heart failure/ arrythmia + Tachycardia (out of proportion) + Elevated cardiac enzymes + ECHO findings s/o cardiac dysfunction + ECG changes
- 30. Treatment General • Hospital admission •Bed rest • Restrict physical activity • Supplemental oxygen • IV fluids
- 31. Treatment Medical • Treat heartfailure- Diuretics, ACE inhibitors, B- blockers • Manage arrhythmia • Avoid NSAIDs • IVIG or corticosteroids (in auto-immune cases) • Antibiotics- in bacterial causes
- 32. Prognosis • Poor innewborns (75% mortality) • Better in children and adolescents • 5 -15% patients require cardiac transplantation • A sub-set of patients develop dilated cardiomyopathy
- 33.