Clinical Presentation of Myocarditis in the Pediatric Age Group and Predictors of Poor Early and Late Outcomes: Academic Hospital Experience

BACKGROUND: Myocarditis is a leading cause of morbidity and mortality in the pediatric age group and contributes to a wide range of complications, including dilated cardiomyopathy, congestive heart failure, and even death, so early identification and comprehensive management are essential for a favorable outcome. OBJECTIVES: Summarize the presenting clinical signs and symptoms of pediatric patients with a diagnosis of myocarditis and a poor outcome and correlate the clinical presentation and laboratory and radiographic findings to identify possible predictors of a poor outcome. METHODS: This retrospective cohort study included all patients who were diagnosed with myocarditis and followed up at King Abdulaziz University Hospital, Jeddah, Saudi Arabia over the 13 years between January 01, 2007, and December 31, 2019. Information on patient demographics, clinical presentation, and non-invasive investigations was obtained. Poor outcomes were defined as death or evidence of left ventricular dysfunction on echocardiography which was evaluated at two points in time as an early outcome and a late outcome. RESULTS: Seventeen patients (male 52.9%, female 47.1%) with a median age of 4 ± 4.31 years are included. The most frequent initial complaints were exercise or feeding intolerance, respiratory symptoms, and shortness of breath. On the other hand, hepatomegaly and respiratory distress were the most common clinical signs. All the patients were admitted to the pediatric intensive care unit but only 41% required mechanical ventilation. The presence of a murmur at presentation was significantly correlated with a poor early outcome. Ischemic changes on the electrocardiogram and moderate left ventricular dysfunction on the echocardiogram were significantly correlated with a poor late outcome. CONCLUSION: Diagnosis of myocarditis can be established by a combination of clinical presentation and investigative tools. A murmur, ischemic changes on the electrocardiogram, and left ventricular dysfunction are important predictors of myocarditis in children.