Clinical and echocardiographic evaluation of our patients with myopericarditis

Abstract

Objective: Chest pain, shortness of breath, increased cardiac biochemical markers and electrocardiographic changes suggest myocarditis in the pediatric age group. We aimed to evaluate our patients with myopericarditis, retrospectively. Material and Methods: Eighteen patients who were diagnosed with myopericarditis between January 2014-December 2017 were evaluated. Results: The age of the patients ranged from 5 months to 17 years (12.8±5). Complaints were chest pain in 16 (88%) patients, fever in 1 patient, respiratory distress and reduction in effort capacity in 1 patient. Twelve patients had upper respiratory tract infection, and one patient had a scorpion injection. The number of white cells was 10045±2706/mm 3 (5900-14580); C-reactive protein was 5.3±6.3 mg/dL (0.01-19). Cardiac enzymes were higher in all patients. The mean creatin kinase myocardial band level was 36.2±11.2 ng/mL (0.8-167) and the mean troponin T was 0.61±0.15 ng/mL (0.051-2.65). The mean level of pro-B type natriuretic peptide from seven patients due to heart failure was 5.122±2.851 pg/mL (110-20.286). Cytomegalovirusimmunglobulin M in one patient and Epstein-Barr virus-immunglobulin M in two patients were positive. Rhinovirus in 5 patients and Adenovirus in 3 patients were detected in the multiplex polymerase chain reaction respiratory tract panel. Electrocardiographic (ECG) evaluation showed sinus tachycardia in 9 patients, ST-T changes in chest leads in 11 patients, and voltage drop in 6 patients. The mean ejection fraction was 68.2±2.9 (35-88). Ten patients had pericardial effusion. Three patients underwent myocardial perfusion scintigraphy and two patients underwent cardiac magnetic resonance imaging. Ten patients were treated with ibuprofen (30 mg/kg/day) and intravenous immunoglobulin (2 g/kg/24 h) was given to twelve patients who showed elevated levels of troponin T in the follow-up. A case of toxic myocarditis developed after scorpion insertion was treated with doxazosin and antivenom. On follow-up, cardiac enzymes remained high on average 6±3.1 (2-13) days. The mean duration of hospitalization was 6±3.6 (2-16) days. Conclusion: Patients with elevated cardiac enzymes and/or ECG changes should be evaluated for myocarditis. © 2018 by Türkiye Klinikleri.