Acute myocarditis in children: current concepts and management

Area of Science:

• Pediatric Cardiology
• Cardiovascular Imaging
• Critical Care Medicine

Background:

• Pediatric myocarditis presents with a wide range of symptoms, from mild illness to cardiogenic shock.
• Traditional diagnosis relied on endomyocardial biopsy, which carries risks in children.
• Cardiac MRI is emerging as a key tool for diagnosis and prognosis.

Purpose of the Study:

• To highlight the evolving diagnostic landscape of pediatric myocarditis.
• To emphasize the role of cardiac MRI in noninvasive evaluation.
• To discuss current management strategies based on disease severity.

Main Methods:

• Review of current literature and clinical practice guidelines for pediatric myocarditis.
• Focus on the diagnostic utility and prognostic value of cardiac MRI.
• Analysis of supportive and advanced therapeutic approaches.

Main Results:

• Cardiac MRI offers a noninvasive method for diagnosing acute myocarditis and predicting outcomes in children.
• Supportive care is the primary management strategy, with heart failure medications used for subacute cases.
• Fulminant myocarditis requires aggressive support, including mechanical circulatory assistance, with high recovery rates.
• Immunosuppressive therapies have shown limited proven benefit in randomized trials.

Conclusions:

• Cardiac MRI is transforming the diagnosis and prognostication of pediatric myocarditis.
• Management strategies are tailored to presentation severity, prioritizing supportive care.
• Mechanical circulatory support and heart transplantation remain critical options for severe, refractory cases.
• Further research is needed to clarify the role of immunomodulatory therapies.