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Cardiac involvement in childhood polyarteritis nodosa
1Department of Pediatric Cardiology, Social Security Hospital of Children, Ankara, Turkey.
Insights
Cardiac evaluations in children with polyarteritis nodosa revealed common systolic dysfunction and valve regurgitation. These findings suggest potential subclinical cardiac involvement even in asymptomatic patients, warranting further monitoring.
Area of Science:
- Pediatric Cardiology
- Rheumatology
- Systemic Vasculitis
Background:
- Polyarteritis nodosa (PN) is a systemic vasculitis affecting medium-sized arteries.
- Cardiac involvement in PN has been reported, but specific findings in pediatric populations require further elucidation.
- Previous reports highlighted severe cardiac complications, necessitating a re-evaluation of cardiac manifestations in children with PN.
Purpose of the Study:
- To assess the cardiac findings in a cohort of pediatric patients diagnosed with polyarteritis nodosa.
- To identify common cardiac abnormalities, including systolic function and valvular abnormalities, in this patient group.
- To compare the observed cardiac complications with those reported in previous literature.
Main Methods:
- Retrospective evaluation of 15 children (age 4-14 years) with confirmed polyarteritis nodosa.
- Comprehensive cardiac assessment including echocardiography.
- Clinical and electrocardiographic evaluation for signs of myocardial infarction or ischemia.
Main Results:
- Diminished left ventricular systolic function was the most frequent finding.
- Mild mitral and/or tricuspid valve regurgitation was commonly observed.
- Pericardial thickening (without effusion) and sinus tachycardia were noted in individual patients.
- No clinical or electrocardiographic evidence of myocardial infarction or ischemia was detected.
Conclusions:
- Cardiac complications like pericarditis or myocardial infarction appear less frequent in this pediatric cohort than previously suggested.
- Subclinical systolic dysfunction and valvular involvement are common in children with polyarteritis nodosa, even in the absence of overt symptoms.
- These findings may stem from underlying histological changes in the myocardium and atrioventricular valves.
- Long-term echocardiographic follow-up is recommended to monitor the progression of cardiac involvement in these patients.
Abstract:
In this report, we evaluated the cardiac findings of 15 children with polyarteritis nodosa. The age range of the patients was 4-14 years; with a mean of 10 years. All have had systemic involvement of the disease. The most common findings in cardiac evaluation were diminished left ventricular systolic functions and mild mitral and/or tricuspid valve regurgitation. One patient had pericardial thickening with no effusion. One had sinus tachycardia. There were no signs of myocardial infarction or ischemia clinically or electro-cardiographically. In conclusion, we did not find cardiac complications, such as pericarditis or myocardial infarction, to be as frequent as in previous reports. However, even in asymptomatic patients, systolic dysfunction or valvular involvement were common findings in patients with polyarteritis nodosa, which were not reported previously. These findings may be due to the histological changes of the myocardium or atrioventricular valves. Although these were not severe and fatal lesions, long-term follow-up of these patients with echocardiography may help to determine the course of cardiac involvement.