The Clinical Outcomes of Acute Myocarditis in Pediatric Population: A Prospective Study

Abstract

Background: Myocarditis, a serious complication of acute viral infections, is a significant concern in pediatric healthcare. Often underdiagnosed due to its subtle symptoms like cough and easy fatigability, myocarditis can lead to severe cardiac complications. Objectives: The primary objective of this study was to examine the outcomes of acute myocarditis in children who received early diagnosis and management. The study focused on identifying factors influencing these outcomes, rather than comparing different treatment methods. Methods: This prospective study involved 118 pediatric patients (age < 16 years) admitted with acute myocarditis to the Pediatric Cardiology Ward at Lady Reading Hospital. Data were collected using a specialized proforma with informed consent. Comprehensive monitoring included echocardiography for assessing left ventricular function, ECG for arrhythmia detection, and cardiac enzyme levels. Patients were treated with a standard management plan, including immunosuppressive therapy, diuretics, and inotropic support. Follow-up was conducted for an average of six months. Results: The age distribution was as follows: 70 patients in Group-A (below 4 years), 35 in Group-B (5-10 years), and 13 in Group-C (10-16 years). The gender ratio was 53 males to 65 females. Ejection fractions were: 15-20% in 40 patients, 20-25% in 44 patients, and 26-35% in 34 patients. Left Ventricular End-Diastolic Diameter (LVEDD) showed 49 patients in Grade 1, 45 in Grade 2, and 24 in Grade 3. Improvements were observed in 37 patients (31.3%) with normal ventricular functions, 32 (27.1%) with mild dysfunction, and 29 (24.5%) with moderate dysfunction. 20 patients (16.9%) showed no improvement, and complications included LV clot (11%), stroke (2.5%), arrhythmias (1.7%), and mortality (5.9%). Conclusion: Timely diagnosis and appropriate management are crucial for improving outcomes in children with acute myocarditis. Delayed management can lead to severe complications including dilated cardiomyopathy, cardiac thrombi, stroke, arrhythmias, and mortality.