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The wheezer that wasn't
J I Singer1, D J Isaacman, L M Bell
1Department of Pediatrics, University of Pittsburgh School of Medicine, PA.
Insights
Pediatric myocarditis can present subtly in infants, with symptoms like tachycardia and heart failure signs. Misdiagnosis as asthma is common, potentially worsening outcomes for young children with cardiac dysfunction.
Area of Science:
- Pediatric Cardiology
- Pediatric Critical Care Medicine
Background:
- Myocarditis in children can present with subtle signs of cardiac dysfunction, particularly in infants and toddlers.
- Older children may exhibit chest pain, but preverbal children cannot articulate symptoms, complicating diagnosis.
Observation:
- Cardiac compromise in young children may manifest as gallop rhythm, tachycardia, arrhythmias, murmurs, rubs, and congestive heart failure.
- Wheezing in a child with asthma history can mask underlying cardiac issues, leading to delayed or incorrect treatment.
Findings:
- Subtle cardiac dysfunction in pediatric myocarditis is often overlooked.
- Misinterpreting cardiac symptoms as respiratory illness, like asthma, can lead to inappropriate therapies.
Implications:
- Early recognition of cardiac dysfunction in pediatric myocarditis is crucial for timely intervention.
- Awareness among emergency physicians is needed to differentiate cardiac from respiratory symptoms in children.
- Appropriate management of pediatric myocarditis requires accurate diagnosis to avoid adverse outcomes from treating the wrong condition.
Abstract:
The expression of cardiac dysfunction in pediatric patients with myocarditis may not be conspicuous. While older children with myocarditis may abruptly present with pleuritic or angina-like pain, infants and toddlers with fulminant disease are unable to verbalize such complaints. Cardiac compromise in preverbal children may only be inferred from variable examination findings that include gallop rhythm, tachycardia, malignant dysrhythmias, murmur, rub, and signs of congestive heart failure. The emergency physician is likely to overlook a cardiac origin for wheezing in a child with a past medical history of asthma. Therapeutic modalities chosen for reactive airway disease may adversely influence the outcome of a patient with myocarditis.