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Myocarditis in children

 
, medical expert
Last reviewed: 12.07.2025
 
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Myocarditis in children is a disease characterized by damage to the heart muscle of an inflammatory nature, caused by direct or mediated through immune mechanisms exposure to infection, parasitic or protozoan invasion, chemical and physical factors, and also arising from allergic, autoimmune diseases and heart transplantation.

Myocarditis can be an independent disease or a component of various diseases (for example, systemic vasculitis, connective tissue diseases, infective endocarditis, etc.). In children, myocarditis is often accompanied by pericarditis (myopericarditis).

ICD10 code

  • 101.2. Acute rheumatic myocarditis.
  • 109.0. Rheumatic myocarditis.
  • 140. Acute myocarditis.
    • 140.0. Infectious myocarditis.
    • 140.1. Isolated myocarditis.
    • 140.8. Other types of acute myocarditis.
    • 140.9. Acute myocarditis, unspecified.
  • 141.0. Myocarditis in bacterial diseases classified elsewhere.
  • 141.1. Myocarditis in viral diseases classified elsewhere.
  • 141.2. Myocarditis in infectious and parasitic diseases classified elsewhere.
  • 141.8. Myocarditis in other diseases classified elsewhere.
  • 142. Cardiomyopathy.
  • 151.4. Myocarditis, unspecified.

198.1. Cardiovascular disorders in other infectious and parasitic diseases classified elsewhere. It should be noted that the International Statistical Classification of Diseases (ICD-10) adopted in 1995 includes a category of "acute myocarditis", although the concept of "chronic myocarditis" is absent. Therefore, if an inflammatory disease of the myocardium is not acute (protracted or chronic), but relatively benign, it can be classified under the category of "myocarditis - 141.1; 141.0; 141; 141.2; 141.8; 151.4". This implies that the disease is secondary. If inflammation of the heart muscle has an unfavorable course, characterized by progressive heart failure, cardiomegaly, it should be classified under the category of "cardiomyopathy".

Epidemiology of myocarditis in children

Given the diversity of the clinical picture of myocarditis, its frequency in the general population remains unknown. Pathological data indicate that, based on the results of 1,420 autopsies of children aged 8 days to 16 years, myocarditis was detected in 6.8% of cases, while in 3,712 autopsies of adults - 4% of cases. According to R. Friedman, among suddenly deceased children aged 1 month to 17 years, myocarditis was diagnosed in 17% of cases. According to the results of pathological studies presented by Okuni, out of 47 suddenly deceased schoolchildren, chronic myocarditis was detected in 21%. During epidemics, the frequency of myocarditis increases significantly. Thus, during the epidemic of 1990-1996. in the toxic form of diphtheria its frequency reached 40-60%, and among the causes of deaths, myocarditis accounted for 15-60% of cases. Myocarditis is most often encountered in children during epidemics caused by the Coxsackie B virus, it is characterized by a high mortality rate (up to 50%) in newborns and children in the first years of life.

Recently, there has been an increase in the incidence of myocarditis, which is associated with both improved diagnostics and an increase in the number of allergic reactions, changes in the body's reactivity, immunization, the growth and prevalence of respiratory viral infections, the emergence of previously unknown diseases affecting the myocardium, and the evolution of the course of most diseases.

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Causes of myocarditis

The causes of myocarditis in children are varied. It develops in pathological conditions that are accompanied by hypersensitivity, such as acute rheumatic fever, or as a result of exposure to radiation, chemicals, drugs, physical impacts. Myocarditis often accompanies systemic diseases of connective tissue, vasculitis, bronchial asthma. Burn and transplant myocarditis are distinguished separately.

What causes myocarditis in children?

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Symptoms of myocarditis in children

Myocarditis, as an inflammatory disease of the myocardium, in most pediatric patients occurs without pronounced cardiac symptoms, and often asymptomatically, usually benign or subclinical. On the other hand, in sudden infant death syndrome, acute myocarditis is often diagnosed as the cause of death at autopsy. It should be noted that children rarely actively complain; more often, parents notice the child's health problems.

Symptoms of myocarditis

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Diagnosis of myocarditis

All patients with suspected myocarditis should undergo the following studies:

  • collection of life history, family history, and disease history;
  • physical examination;
  • laboratory tests;
  • instrumental studies.

The diagnostic search necessarily includes a thorough analysis of the anamnesis of the disease, paying special attention to the connection of cardiac symptoms with previous episodes of viral, bacterial infections and unclear fever, all kinds of allergic reactions, vaccinations. However, in pediatric practice, there are often cases of myocarditis, where there is no specific link between the heart disease and specific etiological causes.

Diagnosis of myocarditis

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Treatment of myocarditis in children

The tactics of managing patients with myocarditis depend on the nature of the disease. Acute viral myocarditis often proceeds favorably and ends in recovery without any treatment. Patients with acute clinically expressed myocarditis are subject to hospitalization.

Chronic myocarditis in 30-50% of children acquires a recurrent course, leading to the progression of chronic heart failure. In this case, it is necessary to carry out a consistent multi-stage complex of treatment and rehabilitation measures first in a hospital, and then in a sanatorium or outpatient clinic. The inpatient stage of treatment of patients with chronic myocarditis lasts from 6 to 8 weeks and includes non-drug (general measures) and drug treatment, sanitation of foci of chronic infection, as well as initial physical rehabilitation.

The main directions of drug treatment are determined by the main links in the pathogenesis of myocarditis: infection-induced inflammation, inadequate immune response, death of cardiomyocytes (due to necrosis and progressive dystrophy, myocarditic cardiosclerosis), and impaired cardiomyocyte metabolism. It should be taken into account that in children myocarditis often occurs against the background of chronic focal infection, which becomes an unfavorable background (intoxication and sensitization of the body), contributing to the development and progression of myocarditis.

Treatment of myocarditis

Prognosis for myocarditis in children

Acute myocarditis in children generally proceeds favorably and ends in recovery even without treatment, although there are known cases of fatal outcomes.

The appearance of symptoms of severe heart failure in acute myocarditis in children is not considered evidence of an unfavorable outcome or transition to the chronic phase. In most cases, laboratory and instrumental indicators normalize within a month.

Asymptomatic myocarditis usually ends in complete recovery. However, in some patients, mainly after a long latent period, chronic myocarditis may develop with transformation into dilated cardiomyopathy.

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