Children with Myocarditis: Clinical Profile and Electrocardiographic Changes and Their Prognostic Significance: A Prospective Observational Study

Abstract

Aims and Objective: To study the clinical profile and electrocardiographic changes in children with myocarditis and their prognostic significance. Methods: 223 children presented with signs and symptoms of myocarditis from June 2016 to May 2017. Amongst them, 21 children with congenital heart disease or rheumatic heart disease and 166 children with negative cardiac markers were excluded. The remaining 36 patients with myocarditis and elevated levels of both SGOT and CKMB were studied. The patient outcome was recorded as expired or discharged. Data were analyzed using the chi-square test. Results: Majority (13; 36%) were infants. Post infancy, there was a uniform age distribution of cases. Myocarditis was commonly seen in association with culture-negative (probably viral) pneumonia, and diphtheria. Bradycardia and A-V block, although seen less frequently, were having a significant association with mortality. Congestive cardiac failure (28.6%) and cardiomegaly (25.0%) were not significantly associated with mortality. ECG changes like Sinus tachycardia and T wave inversion (most common) and ST elevation, Q waves and low amplitude (less common) were insignificantly associated with mortality.   Conclusion: In children, myocarditis should be suspected especially in infants with unexplained breathlessness or fatigue, arrhythmia, or signs of acute cardiac decompensation. It was seen more with bacterial-culture-negative (viral) pneumonia and diphtheria. Continuous ECG monitoring and chest X-ray should be done. Congestive cardiac failure and cardiomegaly, though observed in a quarter of patients were not significantly associated with mortality. Bradycardia and A-V block have a poor prognosis and cardiac pacing should be considered. Echocardiography should be available in-house.