Cardiac arrhytmias and acute myocarditis in children - clinical and electrocardiographical study

Abstract

Introduction: The diagnosis of acute myocarditis (MA) is complicated due to various clinical manifestations - from asymptomatic supraventricular arrhythmias to severe heart failure. The diagnosis of MA should be based"on anamnesis data, physical examination, laboratory investigation results (specific serological markers), noninvasive instrumental methods (EKG, EcoCG), and, if necessary, invasive methotds (endomyocardial biopsy). Aim: Assessing the proportion and types of arrhythmias in children with acute myocarditis. Objectives: - to analyze the clinical and paraclinical features of MA in children. - to assess and analyze arrhythmias on standard EKG in children with MA. - to estimate the importance of Holter monitoring in establishing the primary diagnosis of arrhythmias associated with MA. Material and methods: The study was retrospective, analyzing the observation cards of 54 children with primary diagnosis of MA, treated in the cardiology department IC§DOSM§iC during the years 2009 - 2010, of whom were selected 25 children with rhythm disorders. Patients underwent clinical examination, biochemical analysis and instrumental investigations (EKG, EcoCG mode M, B, Doppler) for the establishment of the clinical diagnosis. Results: The study included 9 girls and 16 boys, with an average age of 8,3 ± 5,67 years. Anamnestic data revealed in 17 (68%) children a prodrome of a viral infection. About 80% of children had clinical signs of cardiac and respiratory disorders. At admission, 20 (80%) children presented signs of heart failure associated with rhythm disorders. Standard EKG showed: supraventricular extrasystoles in 5 (20,83%) cases, ventricular extrasystoles in 3 (12,5%) cases, extra-junctional extrasystoles in 2 (8,33%) cases, atrio-vetricular dissociation in 2 (8,33%) cases, sinus tachycardia in 2 (8,33%) cases, repolarization process disorders in 2 (8,33%) cases, idioventricular rhythm in 1 (4,16%) case. Holter monitoring has allowed the tracking of the following transitory and concealed arrhythmias: sinus rhythm with shift to atrial rhythm in 2 (25%) patients, sinus tachycardia in 4 (50%) patients, supraventricular extrasystoles in 6 (75%) patients, ventricular extrasystoles in 5 (62,5%) and a case of ventricular tachycardia (12,5%). Conclusions: Of the total number of 54 children with MA, 25 (46,3%) had various isolated and combined arrhythmias and 17 (68%) children had a history of a viral prodrome. The most common arrhythmias revealed with standard EKG were associated with a I-II degree heart failure in 8 (40%) children, of whom 3 with sinus tachycardia, 2 with supraventricular extrasystoles, and 1 child with ventricular extrasystole. Holter monitoring allowed to determine arrhythmias undetected by EKG at rest, including 6 (11,1%) cases of arrhythmias with an increased sudden death risk.