Pediatric Acute Infectious Myocarditis Risk Management Pitfalls and Key Points

Risk Management Pitfalls:

1. Failure to identify myocarditis in a patient presenting with respiratory distress and cardiomegaly on chest radiograph. 

2. Failure to identify myocarditis in a patient presenting with new onset recalcitrant arrhythmias. 

3. Failure to have resuscitative equipment available.

Key Points:

1. Patients with acute myocarditis often present with vague symptoms not clearly referable to the cardiovascular system. Therefore, one must keep a high index of suspicion when caring for patients with viral symptomatology. 

2. The true incidence of acute myocarditis is unknown. For this reason, definitive determination of outcome is not possible. 

3. The pathobiology of acute myocarditis is complex and not completely understood. There are ill-defined virus and host factors that determine the severity of the disease course. 

4. The development of chronic, dilated cardiomyopathy is a common sequela of the acute infectious process. 

5. An elevated troponin level may support the diagnosis of myocarditis, but a normal troponin level does not exclude the diagnosis.

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