الفهرس 
MYOCARDITISOnly 14 pages are availabe for public view
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Abstract
M
yocarditis is an inflammatory disease of the heart, frequently resulting from viral infections and/or post-viral immune-mediated responses. Secondary causes of myocarditis can be due to specific pathogens, which include bacteria, spirochetes, rickettsiae, fungi, protozoa, drugs, chemicals, physical agents, and other inflammatory diseases such as systemic lupus erythrematosus.
The diagnosis is presumed based on clinical presentation and noninvasive diagnostic methods such as cardiovascular magnetic resonance imaging and echocardiography. Clinical picture widely ranges from the severe sudden onset of a cardiogenic shock to asymptomatic patients.
Myocarditis is an important cause of morbidity and mortality in children, leading to long-term sequelae including chronic congestive heart failure, dilated cardiomyopathy, heart transplantation, and death.
Speckle tracking ECHO is a quantitative, objective technique for intrinsic cardiac deformation in real time, providing an accurate assessment of abnormal regional wall contractility as in myocarditis. Several studies have shown the superiority of strain imaging over the conventional methods used for the assessment of myocardial dysfunction.
In our study, female patients percentage was higher than that of males with carditis; the most common cause was a viral cause; other causes were seen secondarily to other diseases such as systemic Lupus erythemoutous, diabetic ketoacidosis, post-renal failure, and kaussaki.
The most common symptoms and signs were tachycardia and tachypnea in 90% of patients and fever in 50%, followed by gastrointestinal symptoms such as vomiting and abdominal pain.
Laboratory investigations show elevations of inflammatory markers TLC, C-reactive protein, and aspartate aminotransferase (AST) in 48% of patients.
Most patients receive IVIG and steroids, and 4 patients need inotropic support. Low cardiac function and low global longitudinal strain are seen in 10% of patients at presentation. In follow-up 4 weeks later, all patients had normal global longitudinal strain, but less in the patient group than in the control group.
2D speckle tracking echo is important to follow up on any cardiac abnormalities to detect any subtle cardiac lesions.
Early recognition is essential in order to monitor and start supportive treatment prior to the development of severe adverse events.
CONCLUSION
M
yocarditis is an acute inflammatory disease. We studied 30 children with carditis and 30 controls of the same age and sex. Most of the patients had clinical presentation of palpitation and dyspnea, 10% had low cardiac function and left ventricle dilation with a low global longitudinal strain by a 2D speckle-tracking echocardiograph, and follow-up 4 weeks after improvement and discharge showed improvement of cardiac function and global longitudinal strain but a lower value than control.
RECOMMENDATION
• To be oriented about the clinical presentation of myocarditis that may be mimicked as pneumonia, heart failure, or gastroenteritis presentation.
• An echocardiograph is an important tool in the diagnosis and evaluation of cardiac function for any patient suspected of having myocarditis.
• To be rapid in diagnosis and treatment to prevent fulminant disease.
• A 2D speckle-tracking echocardiograph is recommended to detect subclinical cardiac impairment even with a normal ejection fraction and in follow-up to prevent perminant lesions.