From the Guidelines
Acute myocarditis in a 1-year-old is a life-threatening condition that requires immediate medical attention, and the most recent guidelines recommend aggressive supportive care, including respiratory support, careful fluid management, and medications such as inotropes to support cardiac function 1. The most common cause of acute myocarditis in children is viral infection, particularly enteroviruses, adenoviruses, and parvovirus B19. Death occurs due to severe cardiac dysfunction, arrhythmias, or cardiogenic shock. Initial symptoms may be nonspecific, including fever, irritability, poor feeding, and respiratory distress, making early diagnosis challenging.
Diagnosis and Treatment
Diagnosis typically involves clinical assessment, cardiac biomarkers (troponin), electrocardiogram, echocardiography, and sometimes cardiac MRI or endomyocardial biopsy.
- Treatment focuses on supportive care, including:
- Respiratory support
- Careful fluid management
- Medications such as inotropes (dopamine 5-20 mcg/kg/min or milrinone 0.25-0.75 mcg/kg/min) to support cardiac function
- Immunomodulatory therapy with intravenous immunoglobulin (2 g/kg over 24 hours) may be used in severe cases
- Advanced support with extracorporeal membrane oxygenation (ECMO) might be necessary in critical situations
Prevention and Prognosis
Prevention involves avoiding exposure to sick contacts and maintaining good hand hygiene. The mortality rate for fulminant myocarditis in infants can be significant despite optimal care, highlighting the importance of early recognition and prompt intensive care management 1. According to the European Society of Cardiology guidelines, patients with fulminant myocarditis have a high acute mortality and a severe risk of life-threatening refractory ventricular tachyarrhythmias, and aggressive haemodynamic support using percutaneous cardiopulmonary support or an intra-aortic balloon pump in addition to drug therapy is recommended 1. In patients who initially present with an HF syndrome suggestive of first DCM manifestation and in whom possible or probable acute myocarditis is suspected, supportive measures with a recommendation to avoid exercise and use of pharmaceutical treatment with neurohormonal blockade with ACE inhibitors and beta-blockers is recommended 1.
From the Research
Acute Myocarditis in a 1-Year-Old
- Acute myocarditis is a serious condition that can affect people of all ages, including children 2.
- The aetiology of acute myocarditis is broad, including infective and inflammatory conditions, as well as exposure to toxic agents 2.
- Clinical features of acute myocarditis can be varied and overlap with other acute cardiac conditions, making diagnosis a challenge 2.
- Cardiovascular magnetic resonance imaging is currently the gold standard non-invasive diagnostic modality for acute myocarditis 2.
Mortality Rate
- The mortality rate for acute myocarditis is approximately 1% to 7% globally 3.
- In the UK, the all-cause mortality for patients presenting to hospital with acute myocarditis is approximately 4% 2.
- Approximately 2% to 9% of patients with acute myocarditis have hemodynamic instability, which is associated with a higher mortality rate of approximately 28% at 60 days 3.
Diagnosis and Treatment
- Diagnosis of acute myocarditis can be suggested by presenting symptoms, elevated biomarkers, electrocardiographic changes, and echocardiographic wall motion abnormalities or wall thickening 3.
- Treatment of acute myocarditis depends on acuity, severity, clinical presentation, and etiology, and may include supportive care, immunosuppression, and advanced treatment options 3, 4.
- There is emerging evidence for immunosuppressive therapy in certain cases of acute myocarditis, but more research is needed to determine the optimal treatment approach 3, 4.
Specific Case of a 1-Year-Old
- There is limited information available on the specific case of a 1-year-old with acute myocarditis causing death.
- However, it is known that acute myocarditis can be a fatal condition, especially if left untreated or if treatment is delayed 5, 6.
- Further research is needed to understand the causes and consequences of acute myocarditis in children, and to develop effective treatment strategies for this age group.