The Diagnostic and Clinical Approach to Acute Myopericardial Syndromes in Children and Adolescent

Abstract

Objectives: Acute myopericardial syndromes (myopericarditis and perimyocarditis) are most challenging diseases to diagnose and treat in pediatric cardiology. The true incidences of the diseases are unknown because the disease can be subclinical or mild enough to go unrecognized in the context of a viral syndrome. The clinical manifestations of acute myopericardial syndromes vary widely from typical chest pain and changes on electrocardiogram to atypical chest pain, non-specified electrocardiography changes and subclinical left ventricular dysfunction. The aim of this study is to help pediatricians to the evaluation and management of these common and complex clinical syndromes. Material and Methods: The patients who were diagnosed with myopericarditis or perimyocarditis at Dr. Sami Ulus Maternity, Children's Health and Diseases Training and Research Hospital between 2010-2019 were retrospectively evaluated. Patients who had fulminant form of myocarditis or progressing to dilated cardiomyopathy were excluded from the study. The medical records of the patients were examined and age, gender, diagnostic tests and diagnosis were evaluated. Results: During the study period, records of 260 patients were reached, 47 patients were excluded from the study because of fulminant myocarditis and progression to dilated cardiomyopathy. Of the remaining 213 patients, 68% were male, 32% were female and the median age was 156 months (32 to 212 months). Patients diagnosed with perimyocarditis and myopericarditis were admitted with the complaint of chest pain, and the diagnosis was made by history, physical examination, electrocardiography and echocardiography findings. Conclusions: Pediatricians should be aware of the clinical signs and symptoms that should increase the index of suspicion for acute myopericardial syndromes because prompt referral to the emergency department, with access to specialists with expertise in the care and support of these patients, is imperative.

Keywords

• pericarditis
• myocarditis
• children

Çocuk ve Adölesanlarda Akut Miyoperikardiyal Sendromlara Tanısal ve Klinik Yaklaşım

Abstract

Amaç: Akut miyoperikardiyal sendromlar (miyoperikardit ve perimiyokardit) pediatrik kardiyolojide tanı ve tedavisi en zorlayıcı hastalıklardır. Bu hastalıkların gerçek insidansı bilinmemektedir, çünkü viral bir sendrom ile ilişkili olarak belirtileri hafif veya subklinik olabilir. Akut miyoperikardiyal sendromların klinik bulguları tipik göğüs ağrısından elektrokardiyogramdaki değişikliklerden, atipik göğüs ağrısına, özgün olmayan elektrokardiyografi değişikliklerine ve subklinik sol ventrikül disfonksiyonuna kadar değişir. Bu çalışmanın amacı çocuk doktorlarına bu yaygın ve karmaşık klinik sendromların değerlendirilmesinde ve yönetilmesinde yardımcı olmaktır. Materyal ve Method: 2010-2019 yılları arasında Dr.Sami Ulus Kadın Doğum ve Çocuk Sağlığı ve Hastalıkları Eğitim ve Araştırma Hastanesinde miyoperikardit veya perimiyokardit tanısı alan hastalar geriye dönük olarak değerlendirildi. Fulminan form miyokardit olan veya dilate kardiyomiyopatiye ilerleyen hastalar çalışma dışı bırakıldı. Hastaların tıbbi kayıtları incelendi ve yaş, cinsiyet, tanısal testleri ve tanıları değerlendirildi. Bulgular: Çalışma süresi boyunca 260 hastanın bilgilerine ulaşıldı, 47 hasta fulminan miyokardit ve dilate kardiyomiyopatiye ilerleme nedeniyle çalışma dışı bırakıldı. Kalan 213 hastanın % 68'i erkek,% 32'si kadın ve ortanca yaş 156 ay (32-212 ay) idi. Perimiyokardit ve miyoperikardit tanısı alan hastalara göğüs ağrısı yakınması ile başvurmuş ve tanı öykü, fizik muayene, elektrokardiyografi ve ekokardiyografi bulguları ile konulmuştu. Sonuç: Çocuk doktorlarının, miyoperikardiyal sendromların klinik belirti ve bulguları için farkındalıklarını ve şüphe eşiğini artırmaları, bu hastaların erken dönemde bu hastalıkların tanı ve tedavisi konusunda uzman merkezlere ulaşımı için önemlidir.

Keywords

• perikardit
• miyokardit
• çocuk

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