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High-degree atrioventricular block in a child with acute myocarditis

Robert W Caughey1, John M Humphrey2, Patricia E Thomas3

  • 1Tulane University School of Medicine, New Orleans, LA.

Ochsner Journal
|June 19, 2014
PubMed

Insights

Viral myocarditis can cause dangerous heart block in children, but it often resolves quickly. This condition, characterized by electrocardiogram (EKG) abnormalities, usually does not require permanent pacemakers.

Area of Science:

  • Pediatric Cardiology
  • Electrophysiology
  • Infectious Diseases

Background:

  • Viral myocarditis frequently causes transient electrocardiogram (EKG) abnormalities in children.
  • Clinical presentations vary from asymptomatic to severe heart failure, often leading to misdiagnosis due to nonspecific symptoms.
  • EKG abnormalities are highly sensitive, present in over 90% of acute myocarditis cases.

Observation:

  • A 13-year-old female experienced syncope due to high-grade atrioventricular (AV) block from presumed viral myocarditis.
  • EKG abnormalities resolved within 48 hours with close monitoring.
  • This case highlights conduction disturbances in acute myocarditis.

Findings:

  • High-degree AV block is associated with increased myocardial injury in acute myocarditis.
  • The severity of pathological changes correlates with the reversibility of AV block.
  • Conduction disturbances are typically transient.

Implications:

  • Prompt recognition of EKG abnormalities in children with suspected viral myocarditis is crucial.
  • While AV block can be severe, permanent pacemaker implantation is rarely necessary.
  • Understanding the transient nature of these rhythm disturbances aids clinical management.
Abstract

Keywords:
Adams-Stokes syndromeatrioventricular blockcoxsackievirus infectionsmyocarditissyncope

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