Myocarditis guidelines for children also include answers to COVID cases

Guidelines for the diagnosis and treatment of myocarditis in children were recently published and timely proven by the American Heart Association (AHA).

While Scientific statement, Was announced in circulation Approved by the Myocarditis Foundation and developed before the COVID-19 pandemic began. The recommendations should help you suspect the following myocarditis: infection Or vaccination, Because cases have been reported primarily in teens and young adults, according to an additional press release statement From AHA and its scientific leadership.

“Healthcare professionals urge patients with symptoms associated with cardiovascular disease to be inquired about the timing of recent COVID vaccinations, as needed, in order to confirm the diagnosis and provide appropriate treatment promptly. We need to consider it, “says AHA.

They added that cardiologists are the ones to consult if primary care is suspected of myocarditis or other heart-related conditions, and repeated guidance from the CDC.

Nevertheless, the benefits of COVID-19 vaccination Much more The organization claimed that it was a very rare risk of myocarditis and other adverse events. “We strongly recommend that all adults and children over the age of 12 in the United States receive the COVID-19 vaccine as soon as it becomes available,” they write.

Overall, myocarditis lacks a widely accepted definition in both adults and children, making the scope of clinical care and research more difficult.

A scientific statement by Yuk Law, MD and colleagues at Seattle Children’s Hospital recommended a comprehensive clinical assessment.

“Given the invasive and insensitive nature of endocardial myocardial biopsy, the focus of the diagnosis has shifted to reliance on clinical suspicion,” they said.

Clinical criteria alone are not sufficient to clearly confirm the diagnosis of myocarditis by cardiac MRI (CMR) or biopsy, but the combination of clinical features and testing function may make the case clinically suspicious. They say they can upgrade to what they say.

Myocarditis often manifests itself as a fulminant condition in children and is preceded by viral infection in about two-thirds of patients.

The most common symptoms are fatigue, shortness of breath, abdominal pain, and fever. Fever and arrhythmias are common in presentations. Suspected myocarditis associated with the COVID-19 vaccine is the main symptom reported of chest pain.

Patient size, transport and sedation stability, technical competence in the treatment center, and gadolinium contraindications help determine the next step in deciding whether to proceed with CMR or biopsy.

Acute cases can worsen rapidly, so inpatient monitoring, especially continuous rhythm monitoring, should be considered.

According to the statement, early intervention with mechanical circulatory assistance can be life-saving and requires patients to be cared for in a pediatric center with expertise in its use and transplantability.

Treatments often include intravenous immunoglobulins and corticosteroids, but the etiology of systemic autoimmune disease, Kawasaki disease, or COVID-related must be followed. Pediatric multisystem inflammatory syndrome (MIS-C).

Once patient Recover During the acute phase, regular follow-up of heart disease is recommended with echocardiography, electrocardiography, and initial laboratory tests every 1-3 months. A follow-up CMR or biopsy is reasonable if other measures remain abnormal.

Normal contractile function after myocarditis does not necessarily eliminate the risk of sudden death. Competitive sports should be avoided As long as there is active inflammation. Within 3-6 months of diagnosis after other measures have normalized, athletes should undergo 24-hour Holter monitoring and exercise stress testing before returning to competition.

The authors believe that the attention to myocarditis by COVID-19 and these guidelines will facilitate the development of a widely accepted definition of myocarditis, without which advances in targeted therapies will continue to struggle. Expressed expectations.

“A set of criteria for diagnosis based on the accuracy of tests from these studies, using improved cardiovascular diagnostic tools such as comprehensive viral PCR from tissues, biomarkers, immunohistochemistry, CMR, etc. Should be a top priority, “they conclude.