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Acute myocarditis according to age: Presentation, management and early outcomes

Clément Karsenty1,2, Paul Vignaud1, Clara Brusq3

  • 1Department of Pediatric Cardiology, University Hospital, Toulouse, France.

ESC Heart Failure
|May 23, 2025
PubMed

Insights

Acute myocarditis (AM) presents differently in children and adults, with distinct causes and treatments. However, the 30-day prognosis for acute myocarditis is similar across all age groups.

Area of Science:

  • Cardiology
  • Pediatric Cardiology
  • Internal Medicine

Background:

  • Acute myocarditis (AM) is a severe cardiac condition affecting all age groups.
  • Limited multicenter studies exist comparing pediatric and adult AM cases.
  • Understanding age-related differences is crucial for effective management.

Purpose of the Study:

  • To investigate the differences in presentation, etiology, management, and outcomes of acute myocarditis between children and adults.
  • To identify factors influencing AM severity and prognosis across pediatric and adult populations.
  • To inform the development of tailored treatment strategies for AM.

Main Methods:

  • A comprehensive French national cohort study analyzed 745 patients (328 children, 417 adults) from March 2020 to November 2021.
  • Data collected included baseline characteristics, clinical evolution, management strategies, and in-hospital complications.
  • Myocarditis-related events (MRE) within 30 days were defined as death, cardiogenic shock, cardiac arrest, ventricular arrhythmias, or complete AV block.

Main Results:

  • Children presented with more severe symptoms, including higher rates of heart failure and cardiogenic shock, requiring more intensive support (inotropes, vasopressors, ventilation).
  • Multisystem inflammatory syndrome (MIS) was more common in children (69.8%), while infectious causes predominated in adults (52.4%).
  • Despite differing presentations and treatments (more corticosteroids/immunomodulators in children), 30-day MRE rates were comparable (18.1% in children vs. 13.4% in adults).

Conclusions:

  • Acute myocarditis shows significant variations in presentation, etiology, and management between pediatric and adult patients.
  • Despite these differences, the 30-day prognosis for acute myocarditis is similar in children and adults.
  • Tailored management strategies are essential for optimizing acute myocarditis care across different age demographics.
Abstract

Keywords:
Acute myocarditisEpidemiologyMortalityPaediatric cardiologyPrognosis

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