A concerned clinical situation in pediatric cases: Acutemyopericarditis, experience of a center from Anatolia

Aim: Myopericarditis/Perimyocarditis is an inflammation in the heart muscle. There is an increase in cardiac biochemical markerswith echocardiographic (ECHO) and/or electrocardiographic (ECG) changes in patients. We aimed to investigate the demographic,clinical, laboratory and imaging features and follow-up results of patients diagnosed with acute myopericarditis in our clinic. Materials and Methods: In this study, demographic and laboratory data and physical examination findings of 15 pediatric patientsdiagnosed with myopericarditis between December 2017-September 2020 were retrospectively recorded. Results: Five (33.3%) of the patients were girls, 10 (66.6%) were boys. The first presentation complaint was chest pain in 11 (73.3%)patients, palpitations in two (13.3%) patients, respiratory distress, abdominal pain and vomiting in two (13.3%) patients. Troponinvalues were increased in all cases. N-terminal prohormone brain natriuretic peptide (NT-ProBNP) level was>100 pg/ml in sevenpatients. In treatment, nine patients received ibuprofen, and three patients received inotrope and anticongestive therapy support aswell as intravenous immunoglobulin (IVIG). In the follow-up, heart functions normalized within four months in all cases. Conclusion: Myopericarditis should be considered especially in adolescent boys who present with complaints such as chestpain, palpitations, respiratory distress, and cardiac enzyme elevation and ECG changes. Although the prognosis is good in mostof myopericarditis cases, the risk of morbidity may be high in patients with high initial cardiac enzyme values, delayed cardiacenzyme return to normal, and systolic dysfunction on ECHO, so long-term follow-up of these patients should be done by pediatriccardiologists.

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1. Richardson P, McKenna W, Bristow M, et al. Report of the 1995 World Healt Organization/İnternational Society and Federation of Cardiology Task Force on the Definition and Classification of Cardiomyopathies. Circulation 1996;93:841-2.
2. Parent JJ, Ware SM. Myopericarditis. In: Kliegman RM, St. Geme J, eds. Nelson Textbook of Pediatrics. 21st edition. Philadelphia: Elsevier. P.2471.
3. Ozyurt A, Baykan A, Pamukcu O, et al. Retrospective Evaluation of 28 Patients Diagnosed as Acute Myo/ Pericarditis: Properties of an Epidemia. Turkiye Klinikleri J Med Sci 2013;33:1166-74.
4. Imazio M, Trinchero R. Myopericarditis: Etiology, management, and prognosis. Int J Cardiol Heart Vasc 2008;127:17-26.
5. Manda YR, Baradhi KM. Myopericarditis. In: StatPearls [Internet]. Treasure Island (FL). StatPearls Publishing; 2020. p. PMID: 30521197
6. Lipshultz SE, Wong JC, Lipsitz SR, et al. Frequency of clinically unsuspected myocardial injury at a children's hospital. Am Heart J 2006;151:916-22.
7. Imazio M, Trinchero R. Clinical management of acute pericardial disease: a review of results and outcomes. Ital Heart J 2004;5:803-17.
8. Imazio M, Cecchi E, Demichelis B, et al. Indicators of poor prognosis of acute pericarditis. Clinical features for pericarditis triage. Circulation 2007;115:2739-44.
9. Halsell JS, Riddle JR, Atwood JE, et al. Myopericarditis following smallpox vaccination among vaccinia-naïve US military personnel. JAMA 2003;289:3283-9.
10. Imazio M, Trinchero R. Triage and management of acute pericarditis. Int J Cardiol 2007;118:286-94.
11. Imazio M, Cecchi E, Demichelis B, et al. Myopericarditis versus viral or idiopathic acute pericarditis. Frequency, clinical clues to diagnosis, and prognosis. Heart 2007 [Electronic publication ahead of print].
12. Ammirati E, Cipriani M, Moro C, et al. Clinical Presentation and Outcome in a Contemporary Cohort of Patients With Acute Myocarditis. Circulation 2018;138:1088-99.
13. Gurses D, Oguz M, Yılmaz M. Clinical and Echocardiographic Evaluation of Our Patients with Myopericarditis. Turkiye Klinikleri J Pediatr 2018;27:96-101.
14. Temizkan RC, Nezir MM, Kaya F, et al. Acute myocarditis that confounded by acute myocardial infarction in adolescent patients who applied Pediatric emergency room with chest pain. Family Practice Palliative Care 2017;2:18-21.
15. Imazio M, Brucato A, Barbieri A, et al. Good Prognosis for Pericarditis With and Without Myocardial Involvement Results From a Multicenter, Prospective Cohort Study. Circulation 2013;2:42-9.
16. De A, Myridakis D, Kerrigan M, et al. Varicella Myopericarditis Mimicking Myocardial Infarction in a 17-Year-Old Boy. Tex Heart Inst J 2011;38:288-90.
17. Jin D, Kao CY, Darby J, et al. Salmonella typhimurium myopericarditis: A case report and review of literature. World J Cardiol 2020;12:67-75.
18. Ogawa T, Veinot JP, de Bold ML Kuroski, et al. Angiotensin II receptor antagonism reverts the selective cardiac NT-PROBNP upregulation and secretion observed in myocarditis. Am J Physiol Heart Circ Physiol 2008;294:2596-603.
19. Butts RJ, Boyle GJ, Deshpande SR, et al. Characteristics of Clinically Diagnosed Pediatric Myocarditis in a Contemporary Multi-Center Cohort. Pediatr Cardiol 2017;38:1175-82.
20. Sagarad SV, Thakur BS, Reddy SS, et al. NT-proBNP in Myocarditis after a Scorpion Sting Envenomation. J Clin Diagn Res 2013;7:118-21.
21. Mahrholdt H, Wagner A, Judd RM, et al. Delayed enhancement cardiovascular magnetic resonance assessment of nonischemic cardiomyopathies. Eur Heart J 2005;26:1461-74.
22. Mahrholdt H, Wagner A, Deluigi CC, et al. Presentation, patterns of myocardial damage, and clinical course of viral myocarditis. Circulation 2006;114:1581-90.
23. Cassimatis DC, Atwood JE, Engler RM, et al. Smallpox vaccination and myopericarditis: a clinical review. J Am Coll Cardiol 2004;43:1503-10.
24. Nieminen MS, Heikkila J, Karjalainen J. Echocardiography in acute infectious myocarditis: relation to clinical and electrocardiographic findings. Am J Cardiol 1984;53:1331-7.
25. Wu LA, Lapeyre AC 3rd, Cooper LT. Current role of endomyocardial biopsy in the management of patients with dilated cardiomyopathy and myocarditis. Mayo Clin Proc 2001;76:1030-8.
26. Adler Y, Charron P, Imazio M, et al. 2015 ESC Guidelines for the diagnosis and management of pericardial diseases. Eur Heart J 2015;36:2921-64.
27. Maisch B, Seferovic PM, Ristic AD, et al. Guidelines on the diagnosis and management of pericardial diseases, executive summary; the Task force on the diagnosis and management of pericardial diseases of the European society of cardiology. Eur Heart J 2004;25:587–610.
28. Khatib R, Reyes MP, Smith FE. Enhancement of Coxsackievirus B3 replication in Vero cells by indomethacin. J Infect Dis 1990;162:997-8.
29. Costanzo-Nordin MR, Reap EA, O'Connell JB, et al. A nonsteroidal antiinflammatory drug exacerbates coxsackievirus B3 murine myocarditis. J Am Coll Cardiol 1985;6:1078-82.
30. Spodick DH. Myopericarditis/Perimyocarditis. In: The Pericardium, Marcel Dekker, Inc, New York 2001. p.114.
31. Robinson JL, Hartling L, Crumley E, et al. A systematic review of intravenous gamma globulin for therapy of acute myocarditis. BMC Cardiovasc Disord 2005;5:1- 6.
32. Kiel RJ, Smith FE, Chason J, et al. Coxsackievirus B3 myocarditis in C3H/HeJ mice: description of an inbred model and the effect of exercise on virulence. Eur J Epidemiol 2003;5:348-50.