Pediatric Myopericarditis Presenting to the Emergency Department as Chest Pain: A Comparative Study With Myocarditis
Christopher J Babbitt1, Michael J Babbitt2, Francesca Byrne3
1From the Pediatric Critical Care, Miller Children's and Women's Hospital of Long Beach, Long Beach.
Insights
Myopericarditis is a common cause of pediatric chest pain, presenting differently than myocarditis. This condition has a good prognosis, with specific clinical and laboratory findings aiding diagnosis.
Area of Science:
- Pediatric Cardiology
- Critical Care Medicine
Background:
- Myopericarditis and myocarditis are inflammatory cardiac conditions presenting with chest pain in children.
- Differentiating these conditions is crucial for appropriate management and prognosis.
Purpose of the Study:
- To analyze the clinical characteristics and outcomes of pediatric myopericarditis.
- To compare myopericarditis with myocarditis in a pediatric intensive care unit (PICU) population.
- To identify factors that differentiate myopericarditis from myocarditis.
Main Methods:
- A retrospective database query identified pediatric patients diagnosed with myopericarditis or myocarditis over a 9-year period.
- Clinical data, laboratory results, and cardiac imaging were extracted from electronic health records.
- A classification model was developed using key clinical and diagnostic parameters.
Main Results:
- 36 patients had myopericarditis and 22 had myocarditis; myopericarditis patients were predominantly male (97%) and older (median 16.2 years).
- Myopericarditis presented with higher rates of chest pain and ST changes, but less fever and fewer respiratory symptoms compared to myocarditis.
- Myopericarditis patients had better left ventricular ejection fraction (67% vs 41%), lower troponin, and lower Pediatric Risk of Mortality scores.
- A classification model achieved 95% accuracy in distinguishing myopericarditis from myocarditis.
Conclusions:
- Myopericarditis is a frequent cause of chest pain in the PICU, distinct from true myocarditis.
- The condition has a favorable prognosis, often managed with nonsteroidal anti-inflammatory medications.
- Clinical presentation, cardiac biomarkers, and imaging findings are key differentiators.
Methods:
A database query was performed and identified patients over a 9-year period, and clinical data, laboratory data, and cardiac studies were extracted and analyzed from the electronic health record.
Results:
A total of 36 patients were identified with the discharge diagnosis of myopericarditis and 22 with myocarditis. The median age for myopericarditis patients was 16.2 years, and 97% were male. The median initial troponin was 7.1 ng/mL, the peak was at 16.6 ng/mL, and 58% had ST changes on electrocardiogram. The median length of stay for myopericarditis patients was 1.7 days, and 50% were discharged home on nonsteroidal anti-inflammatory medication. Compared with myocarditis, myopericarditis patients were older, had a higher incidence of chest pain, and were less likely to have fever, vomiting, abdominal pain, upper respiratory infection symptoms, chest radiograph abnormalities, or T-wave inversion (P < 0.05). Myopericarditis patients also had lower Pediatric Risk of Mortality version 3 scores, B-type natriuretic peptide levels, and higher left ventricular ejection fractions on admission (67% vs 41%; P < 0.05). A classification model incorporating initial left ventricular ejection fraction, B-type natriuretic peptide, electrocardiogram, and chest radiograph findings distinguished myopericarditis from myocarditis with correct classification in 95% of patients.
Conclusions:
Myopericarditis is a relatively common cause of chest pain for patients admitted to the pediatric intensive care unit, presents differently than true myocarditis, and carries a good prognosis.
More Related Videos
12:24Noninvasive Assessment of Cardiac Abnormalities in Experimental Autoimmune Myocarditis by Magnetic Resonance Microscopy Imaging in the Mouse
Published on: June 20, 2014
06:16Signal Acquisition, Score Interpretation, and Economics of a Non-Invasive Point-of-Care Test for Coronary Artery Disease
Published on: August 9, 2024
Related Concept Videos
01:27Myocarditis II: Clinical Features and Diagnostic Tests
01:19Pericarditis II: Clinical Features and Diagnostic Tests
01:14Myocarditis III: Medical Management
01:21Myocarditis I: Introduction
01:22Myocarditis IV: Nursing Management
01:30Introduction Cardiac Emergencies