Peds0715 Myocarditis Pericarditis .pdf


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Myocarditis And Pericarditis In
The Pediatric Patient: Validated
Management Strategies
Abstract
Myocarditis and pericarditis are inflammatory conditions of the heart
commonly caused by viral and autoimmune etiologies, although many
cases are idiopathic. Emergency clinicians must maintain a high index
of suspicion for these conditions, given the rarity and often nonspecific
presentation in the pediatric population. Children with myocarditis may
present with a variety of symptoms, ranging from mild flu-like symptoms to overt heart failure and shock, whereas children with pericarditis
typically present with chest pain and fever. The cornerstone of therapy for
myocarditis includes aggressive supportive management of heart failure,
as well as administration of inotropes and antidysrhythmic medications,
as indicated. Children often require admission to an intensive care setting.
The acute management of pericarditis includes recognition of tamponade
and, if identified, the performance of pericardiocentesis. Medical therapies may include nonsteroidal anti-inflammatory drugs and colchicine,
with steroids reserved for specific populations. This review focuses on the
evaluation and treatment of children with myocarditis and/or pericarditis, with an emphasis on currently available medical evidence.
Editor-in-Chief
Adam E. Vella, MD, FAAP
Associate Professor of Emergency
Medicine, Pediatrics, and Medical
Education, Director Of Pediatric
Emergency Medicine, Icahn School
of Medicine at Mount Sinai, New
York, NY

Associate Editor-in-Chief

Ilene Claudius, MD
Associate Professor of Emergency
Medicine, Keck School of Medicine
of the University of Southern
California, Los Angeles, CA
Ari Cohen, MD
Chief of Pediatric Emergency
Medicine Services, Massachusetts
General Hospital; Instructor in
Pediatrics, Harvard Medical School,
Boston, MA

Vincent J. Wang, MD, MHA
Associate Professor of Pediatrics,
Marianne Gausche-Hill, MD, FACEP,
Keck School of Medicine of the
FAAP
University of Southern California;
Professor of Clinical Medicine,
Associate Division Head, Division
David Geffen School of Medicine
of Emergency Medicine, Children's
at the University of California at
Hospital Los Angeles, Los Angeles,
Los Angeles; Vice Chair and Chief,
CA
Division of Pediatric Emergency
Medicine, Harbor-UCLA Medical
Editorial Board
Center, Los Angeles, CA
Jeffrey R. Avner, MD, FAAP Professor Michael J. Gerardi, MD, FAAP,
of Clinical Pediatrics and Chief of
FACEP, President
Pediatric Emergency Medicine,
Associate Professor of Emergency
Albert Einstein College of Medicine,
Medicine, Icahn School of Medicine
Children’s Hospital at Montefiore,
at Mount Sinai; Director, Pediatric
Bronx, NY
Emergency Medicine, Goryeb
Steven Bin, MD
Associate Clinical Professor,
Division of Pediatric Emergency
Medicine, UCSF Benioff Children’s
Hospital, University of California,
San Francisco, CA
Richard M. Cantor, MD, FAAP,
FACEP
Professor of Emergency Medicine
and Pediatrics, Director, Pediatric
Emergency Department, Medical
Director, Central New York Poison
Control Center, Golisano Children's
Hospital, Syracuse, NY

Children's Hospital, Morristown
Medical Center, Morristown, NJ

Pediatric Emergency Medicine, BC
Children's Hospital, Vancouver, BC,
Canada
Alson S. Inaba, MD, FAAP
Associate Professor of Pediatrics,
University of Hawaii at Mãnoa
John A. Burns School of Medicine,
Division Head of Pediatric
Emergency Medicine, Kapiolani
Medical Center for Women and
Children, Honolulu, HI

July 2015

Volume 12, Number 7
Authors
Kelly R. Bergmann, DO
Fellow, Department of Pediatric Emergency Medicine, Children’s
Hospitals and Clinics of Minnesota, Minneapolis, MN
Anupam Kharbanda, MD
Director of Research, Associate Fellowship Director, Department of
Pediatric Emergency Medicine, Children’s Hospitals and Clinics of
Minnesota, Minneapolis, MN
Lauren Haveman, MD
Department of Internal Medicine-Pediatrics, University of
Minnesota, Minneapolis, MN
Peer Reviewers
Richard M. Cantor, MD, FAAP, FACEP
Professor of Emergency Medicine and Pediatrics, Director, Pediatric
Emergency Department, Medical Director, Central New York Poison
Control Center, Golisano Children’s Hospital, Syracuse, NY
Merrick Lopez, MD
Assistant Professor of Pediatrics, Division of Pediatric Critical Care,
Loma Linda University Children’s Hospital, Loma Linda, CA
CME Objectives
Upon completion of this article, you should be able to:
1.
Identify common presenting signs and symptoms of myocarditis
and pericarditis in children.
2. Determine the appropriate diagnostic testing for suspected
myocarditis and pericarditis in children.
3. Identify management strategies for myocarditis and pericarditis
in children.
Prior to beginning this activity, see “Physician CME Information”
on the back page.
Education, Pediatric Emergency
Medicine, Yale School of Medicine,
New Haven, CT
Robert Luten, MD
Professor, Pediatrics and
Emergency Medicine, University of
Florida, Jacksonville, FL

Sandip Godambe, MD, PhD
Tommy Y. Kim, MD, FAAP, FACEP
Vice President, Quality & Patient
Associate Director of Emergency
Safety, Professor of Pediatrics and
Medicine and Pediatrics, Loma
Emergency Medicine, Attending
Linda University Medical Center and
Physician, Children's Hospital of the
Children’s Hospital, Loma Linda, CA;
King's Daughters Health System,
California Emergency Physicians,
Norfolk, VA
Riverside, CA
Ran D. Goldman, MD
Melissa Langhan, MD, MHS
Professor, Department of Pediatrics, Associate Professor of Pediatrics,
University of British Columbia;
Fellowship Director, Pediatric
Co-Lead, Division of Translational
Emergency Medicine, Director of
Therapeutics; Research Director,

AAP Sponsor

Garth Meckler, MD, MSHS
Martin I. Herman, MD, FAAP, FACEP
Associate Professor of Pediatrics,
Professor of Pediatrics, Attending
University of British Columbia;
Physician, Emergency Medicine
Division Head, Pediatric Emergency
Department, Sacred Heart
Medicine, BC Children's Hospital,
Children’s Hospital, Pensacola, FL
Vancouver, BC, Canada

Madeline Matar Joseph, MD, FAAP,
FACEP
Professor of Emergency Medicine and Joshua Nagler, MD
Pediatrics, Chief and Medical Director, Assistant Professor of Pediatrics,
Pediatric Emergency Medicine
Harvard Medical School; Fellowship
Division, University of Florida Medical
Director, Division of Emergency
School-Jacksonville, Jacksonville, FL
Medicine, Boston Children’s
Stephanie Kennebeck, MD
Hospital, Boston, MA
Associate Professor, University of
James Naprawa, MD
Cincinnati Department of Pediatrics, Associate Clinical Professor
Cincinnati, OH
of Pediatrics, The Ohio State
Anupam Kharbanda, MD, MS
Research Director, Associate
Fellowship Director, Department
of Pediatric Emergency Medicine,
Children's Hospitals and Clinics of
Minnesota, Minneapolis, MN

Medical Center, Hartford, CT
Christopher Strother, MD
Assistant Professor, Director,
Undergraduate and Emergency
Simulation, Icahn School of Medicine
at Mount Sinai, New York, NY

University College of Medicine;
Attending Physician, Emergency
Department, Nationwide Children’s
Hospital, Columbus, OH

International Editor
Lara Zibners, MD, FAAP
Honorary Consultant, Paediatric
Emergency Medicine, St Mary's
Hospital, Imperial College Trust;
EM representative, Steering Group
ATLS®-UK, Royal College of
Surgeons, London, England

Pharmacology Editor
James Damilini, PharmD, MS, BCPS
Clinical Pharmacy Specialist,
Emergency Medicine, St. Joseph's
Hospital and Medical Center,
Phoenix, AZ

Joshua Rocker, MD
Assistant Professor of Emergency
Medicine and Pediatric, Hofstra
Quality Editor
North Shore-LIJ School of Medicine,
Hempstead, NY; Associate Director, Steven Choi, MD
Medical Director of Quality, Director
Division of Pediatric Emergency
of Pediatric Cardiac Inpatient
Medicine, Cohen Children's Medical
Services, The Children’s Hospital at
Center, New Hyde Park, NY
Montefiore; Assistant Professor of
Steven Rogers, MD
Pediatrics, Albert Einstein College
Assistant Professor, University of
of Medicine, Bronx, NY
Connecticut School of Medicine,
Attending Emergency Medicine
Physician, Connecticut Children's


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