Is pediatric myocarditis curable?

Written by Yao Li Qin
Pediatrics
Updated on February 17, 2025
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Myocarditis in children is generally caused by a viral infection, which means viral myocarditis is the most common type. This condition indicates that the virus has damaged the myocardial cells, leading to severe symptoms such as heart failure and cardiogenic shock. Once myocarditis is diagnosed in a child, it is crucial to hospitalize and treat them actively. While treating myocarditis, it is essential to use medications that nourish the myocardium and actively treat the primary disease. Most children with myocarditis have a favorable prognosis, but fulminant myocarditis has a poor prognosis, carrying a certain risk of mortality.

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What tests are done for myocarditis?

First is the electrocardiogram, which can show STT changes, including mild ST segment shift and T wave inversion, and various arrhythmias, especially ventricular arrhythmias and atrioventricular conduction blocks. Next is the cardiac ultrasound, also known as echocardiography, which can be normal or show left ventricular enlargement, reduced left ventricular motion, and decreased left ventricular systolic function. Another method is cardiac MRI, which mainly shows evidence of cardiac damage, and this has significant implications for the diagnosis of myocardial conditions. Additionally, biochemical tests include elevated cardiac enzymes, troponin, accelerated erythrocyte sedimentation rate, and other non-specific inflammatory markers. Moreover, there is cardiac biopsy, which is generally invasive and thus mainly used in patients with severe conditions, poor treatment response, or unknown causes. This test is generally not used in patients with mild symptoms. Other tests include chest X-rays and etiological examinations.

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Causes of Myocarditis

Myocarditis is also an inflammatory disease of the myocardium. Common causes are viral infections, such as Coxsackievirus B, Parvovirus B19, Human Herpesvirus 6, and Poliovirus, with Coxsackievirus B being the most common cause, accounting for about 30%-50%. Bacteria, fungi, spirochetes, rickettsiae, and protozoa can also cause myocarditis, but they are relatively rare. Non-infectious causes of myocarditis include drugs, radiation, connective tissue diseases, vasculitis, giant cell myocarditis, among others. These are all causes of myocarditis.

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post-myocarditis syndrome

Patients with myocarditis generally have a self-limiting condition; it can heal completely without any treatment. However, sometimes, some myocarditis cases are fulminant, leading to acute heart failure or sudden death. For self-limiting diseases, since the condition is relatively mild, not receiving timely treatment can leave sequelae, such as some dilated cardiomyopathies, which are often due to the transformation from myocarditis. Therefore, for patients with myocarditis, we should follow up and conduct regular reviews to avoid the occurrence of dilated cardiomyopathy.

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Is pediatric myocarditis serious?

The severity of myocarditis in children needs to be assessed by considering the child's clinical symptoms and corresponding clinical examinations comprehensively. Common clinical symptoms include chest tightness, fatigue, shortness of breath, etc. Most children have a history of upper respiratory tract infection before the symptoms appear. It is necessary to conduct routine blood tests, myocardial enzymes, troponin, myocardial antibodies, viral antibodies, electrocardiograms, and other relevant physicochemical examinations to further clarify the condition. Patients with mild symptoms and roughly normal laboratory results can improve on their own with rest. If there are clinical symptoms such as chest tightness, fatigue, shortness of breath, and related physicochemical examinations show abnormal changes, it is necessary to use medication to nourish the myocardium. During treatment, rest is advised, reduce fatigue, maintain emotional stability, and generally, the symptoms can improve within 10 to 15 days. For more severe cases, the treatment period may need to be extended accordingly.

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the recurrence rate of myocarditis

The most common type of myocarditis clinically seen is viral myocarditis, which is a localized or diffuse cardiac injury resulting from viral infections. Mild myocardial damage, when treated effectively under the guidance of a doctor, typically does not recur after recovery. Recurrence referred to involves serious myocardial damage, or lack of systematic treatment, leading to complications such as heart failure and arrhythmias. These complications often exacerbate under certain triggering factors like infections, colds, excessive fatigue, emotional excitement, overeating, constipation, etc., increasing the cardiac load and causing the recurrence of heart failure and arrhythmias.