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Acute Myocarditis in Children: An Overview of Treatment and Recent Patents
Ronald C M Fung1, Kam L Hon1, Alexander K C Leung2
1Department of Paediatrics and Adolescent Medicine, The Hong Kong Children's Hospital, Kowloon Bay, Kowloon, Hong Kong.
Insights
Pediatric myocarditis, though rare, presents diverse symptoms and is often caused by viral infections. Early suspicion and diagnosis are key for effective management in children.
Area of Science:
- Pediatric Cardiology
- Infectious Diseases
- Cardiovascular Research
Background:
- Pediatric myocarditis is an uncommon yet complex condition affecting children.
- This review synthesizes current knowledge and recent patent activity concerning childhood myocarditis.
Purpose of the Study:
- To provide a comprehensive overview of pediatric myocarditis.
- To summarize current literature on the etiology, clinical presentation, diagnosis, and management of childhood myocarditis.
Main Methods:
- Literature review utilizing clinical queries and keywords: "myocarditis" and "childhood".
- Analysis of current knowledge and recent patent landscape related to pediatric myocarditis.
Main Results:
- Viral infections are the primary cause of acute myocarditis in children, presenting with nonspecific symptoms like fever, malaise, and fatigue.
- Clinical manifestations range from mild symptoms to severe heart failure and cardiovascular collapse; diagnosis relies on high clinical suspicion, cardiac MRI, and endomyocardial biopsy.
- Treatment involves supportive care, heart failure medications, and potentially mechanical circulatory support, with immunosuppression remaining controversial; recent patents target viral myocarditis prevention/treatment, but efficacy data is limited.
Conclusions:
- This review consolidates current understanding of pediatric myocarditis.
- It highlights the importance of early diagnosis and appropriate management strategies for affected children.
Background:
Pediatric myocarditis is rare but challenging. This overview summarized the current knowledge and recent patents on childhood myocarditis.
Methods:
Clinical queries and keywords of "myocarditis" and "childhood" were used as search engine.
Results:
Viral infections are the most common causes of acute myocarditis. Affected children often have a prodrome of fever, malaise, and myalgia. Clinical manifestations of acute myocarditis in children can be nonspecific. Some children may present with easy fatigability, poor appetite, vomiting, abdominal pain, exercise intolerance, respiratory distress/tachypnea, dyspnea at rest, orthopnea, chronic cough with wheezing, chest pain, unexplained tachycardia, hypotension, syncope, and hepatomegaly. Supraventricular arrhythmias, ventricular arrhythmias, and heart block may be present. A subset of patients have fulminant myocarditis and present with cardiovascular collapse, which may progress to severe cardiogenic shock, and even death. A high index of suspicion is crucial to its diagnosis and timely management. Cardiac magnetic resonance imaging is important in aiding clinical diagnosis while, endomyocardial biopsy remains the gold standard. The treatment consists of supportive therapy, ranging from supplemental oxygen and fluid restriction to mechanical circulatory support. Angiotensinconverting enzyme inhibitors, angio-tensin II receptor blockers, β-blockers, and aldosterone antagonists might be used for the treatment of heart failure while, immunosuppression treatments remain controversial. There are a few recent patents targeting prevention or treatment of viral myocarditis, including an immunogenic composition comprising a PCV-2 antigen, glutathione-S-transferase P1, neuregulins, NF-[kappa] B inhibitor, a pharmaceutical composition which contains 2-amino-2- (2- (4-octyl phenyl) - ethyl) propane 1,3-diol, a composition containing pycnojenol, Chinese herbal concoctions, and a Korean oral rapamycin. Evidence of their efficacy is still lacking.
Conclusion:
This article reviews the current literature regarding etiology, clinical manifestations, diagnosis, and management of acute myocarditis in children.
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