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Stokes-Adams attacks due to acute nonspecific myocarditis in childhood
Insights
Pediatric acute nonspecific myocarditis can cause Stokes-Adams attacks due to complete heart block. Isoproterenol effectively restored normal ECG in most young patients, though some experienced persistent conduction abnormalities.
Area of Science:
- Pediatric Cardiology
- Electrophysiology
- Myocarditis Research
Background:
- Acute nonspecific myocarditis is an inflammatory heart condition affecting children.
- Stokes-Adams attacks, characterized by syncope, can result from complete heart block.
- Complete heart block in children necessitates urgent diagnosis and management.
Purpose of the Study:
- To investigate the clinical presentation and management of pediatric patients with complete heart block secondary to acute nonspecific myocarditis.
- To evaluate the efficacy of isoproterenol in reversing complete heart block in this population.
- To characterize the electrocardiographic (ECG) patterns and long-term conduction outcomes.
Main Methods:
- Retrospective analysis of six pediatric patients (ages 1-11) diagnosed with acute nonspecific myocarditis and complete heart block.
- Assessment of treatment strategies including transvenous pacing and pharmacologic intervention with isoproterenol.
- Detailed electrocardiographic analysis during acute phase, treatment, and convalescent period.
Main Results:
- All six patients presented with Stokes-Adams attacks due to complete heart block.
- Isoproterenol normalized ECG in 4 out of 6 patients; 2 required transvenous pacing.
- Common ECG patterns included right bundle branch block with left posterior hemiblock; one patient had complete left bundle branch block.
- Normal atrioventricular conduction returned within 2-24 hours in most survivors.
- One patient died, one experienced persistent bifascicular block, and another had ongoing shock.
Conclusions:
- Acute nonspecific myocarditis is a reversible cause of complete heart block and Stokes-Adams attacks in children.
- Isoproterenol demonstrates significant efficacy in managing acute heart block in this pediatric cohort.
- While recovery is common, persistent conduction abnormalities can occur, highlighting the need for careful monitoring.
Abstract:
Six patients aged between 1 to 11 years (4 females and 2 males) developed Stokes-Adams attacks with complete heart block due to acute nonspecific myocarditis. Transvenous pacing was instituted in 2 patients, but in the other 4 patients the ECG returned to normal by isoproterenol. All ECGs in complete heart block showed QRS complexes of right bundle branch block with left posterior hemiblock pattern, except for 1 which showed QRS complexes of complete left bundle branch block pattern. The ECG improved sequentially in order and left anterior hemiblock pattern of QRS complexes remained to the last during the convalescent period. Normal atrioventricular conduction returned by 2 to 24 hours in all but 1 patient who was dead and 1 of the 2 patients with shock. In another patient bifascicular block has persisted.