The Diagnostic and Clinical Approach to Pediatric Myocarditis: A Review of the Current Literature

Authors

  • Ramush Bejiqi Medical School, University of Gjakova, Gjakova, Kosovo; Pediatric Clinic, University Clinical Center of Kosovo, Prishtina, Kosovo
  • Ragip Retkoceri Pediatric Clinic, University Clinical Center of Kosovo, Prishtina, Kosovo
  • Arlinda Maloku Pediatric Clinic, University Clinical Center of Kosovo, Prishtina, Kosovo
  • Aferdita Mustafa Pediatric Clinic, University Clinical Center of Kosovo, Prishtina, Kosovo
  • Hana Bejiqi Main Center of Family Medicine, Prishtina, Kosovo
  • Rinor Bejiqi Medical School, University of Prishtina, Prishtina, Kosovo

DOI:

https://doi.org/10.3889/oamjms.2019.010

Keywords:

Myocarditis, Cardiomyopathy, Myocardium, Ventricular dysfunction, Cardiac magnetic resonance, Endomyocardial biopsy, Immunomodulation, Immunosuppression

Abstract

Myocarditis is an inflammatory disease of the myocardium with a broad spectrum of clinical presentations, ranging from mild symptoms to severe heart failure. The course of patients with myocarditis is heterogeneous, varying from partial or full clinical recovery in a few days to advanced low cardiac output syndrome requiring mechanical circulatory support or heart transplantation. Myocarditis is a very heterogeneous disease, especially in the pediatric age group as worldwide disease myocarditis has been defined by the World Health Organization/International Society and Federation of Cardiology as an inflammatory disease of the heart muscle diagnosed by established histological, immunologic, and immunohistological criteria. Pediatric myocarditis remains challenging from the perspectives of diagnosis and management. Multiple etiologies exist, and the majority of cases appear to be related to viral illnesses. Enteroviruses are believed to be the most common cause, although cases related to adenovirus may be more frequent than suspected. The clinical presentation is extremely varied, ranging from asymptomatic to sudden unexpected death. A high index of suspicion is crucial. There is emerging evidence to support investigations such as serum N-terminal B-type natriuretic peptide levels, as well as cardiac magnetic resonance imaging as adjuncts to the clinical diagnosis. In the future, these may reduce the necessity for invasive methods, such as endomyocardial biopsy, which remain the gold standard. Management generally includes supportive care, consisting of cardiac failure medical management, with the potential for mechanical support and cardiac transplantation. Treatments aimed at immunosuppression remain controversial. The paediatrics literature is extremely limited with no conclusive evidence to support or refute these strategies. All these summarised in this article and the listed current literature showed that there is no consensus regarding aetiology, clinical presentation, diagnosis, and management of myocarditis in pediatric patients.

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Author Biography

Ramush Bejiqi, Medical School, University of Gjakova, Gjakova, Kosovo; Pediatric Clinic, University Clinical Center of Kosovo, Prishtina, Kosovo

Ramush Bejiqi was born in 1961, in Rama Baje, Medvedja, Yugoslavia. He has graduated medicine 1981-1986 at the Medical Facality in Nish, Serbia, where he completed Master of Scineces in imunology and alergology (1986 – 1988).  He also finished his pediatric specialisation (5 years) in Nish, Serbia (1991 – 1995), as well as subspecialization in cardiology (2 years) in Belgrade, Serbia (1995 – 1997).  He defended his PhD in area of congenital heart disease,  titeled: “Congenital Heart Disease in Neonates with Central Cyanosis†in Tirana, Albania (2010). He was trained in transthoracic echocardiography, transesophageal echocardiography, 3D, 4D; fetal echocardiography; interventional pediatric cardiology; and abdominal echosonography.  He started his professional carrea in 1986-1991 at Medical Center, Leskovac, Medvedja, Serbia. From 1991 and onward he is employed at the Pediatric Clinic, University Clinical Center of Kosovo,  Prishtina, Kosovo. From March, 2010 he is President of Pediatric Association of Republic of Kosovo. He is Member of European Association of Pediatric Cardiologist; Member of  American College of Cardiology;  Fellow of American College of Cardiology, New Orelans, USA; Member of Editorial Board of Medical Journal “Medicusâ€,  Republic of Macedonia. In March 2011 he was elected as a Director of Pediatric Emergency in Prishtina;  in September, 2011 he was elected as a Director of Board for developing Cardiac Surgery Center in Prishtina; and Director of 1st Pediatric School of Pediatric Association of Republic of Kosovo.

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2019-01-03

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1.
Bejiqi R, Retkoceri R, Maloku A, Mustafa A, Bejiqi H, Bejiqi R. The Diagnostic and Clinical Approach to Pediatric Myocarditis: A Review of the Current Literature. Open Access Maced J Med Sci [Internet]. 2019 Jan. 3 [cited 2024 Apr. 19];7(1):162-73. Available from: https://oamjms.eu/index.php/mjms/article/view/oamjms.2019.010

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Vol. 7 No. 1 (2019): Jan 15 (OAMJMS)

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F - Review Articles

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Copyright (c) 2019 Ramush Bejiqi, Ragip Retkoceri, Arlinda Maloku, Aferdita Mustafa, Hana Bejiqi, Rinor Bejiqi

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