Diagnosis and Management of Myocarditis in Children: A Scientific Statement from the American Heart Association

Yuk M. Law, Ashwin K. Lal, Sharon Chen, Daniela Cˇiha´kova´, Leslie T. Cooper, Shriprasad Deshpande, Justin Godown, Lars Grosse-Wortmann, Joshua D. Robinson, Jeffrey A. Towbin

Research output: Contribution to journalReview articlepeer-review

Abstract

Myocarditis remains a clinical challenge in pediatrics. Originally, it was recognized at autopsy before the application of endomyocardial biopsy, which led to a histopathology-based diagnosis such as in the Dallas criteria. Given the invasive and low-sensitivity nature of endomyocardial biopsy, its diagnostic focus shifted to a reliance on clinical suspicion. With the advances of cardiac magnetic resonance, an examination of the whole heart in vivo has gained acceptance in the pursuit of a diagnosis of myocarditis. The presentation may vary from minimal symptoms to heart failure, life-threatening arrhythmias, or cardiogenic shock. Outcomes span full resolution to chronic heart failure and the need for heart transplantation with inadequate clues to predict the disease trajectory. The American Heart Association commissioned this writing group to explore the current knowledge and management within the field of pediatric myocarditis. This statement highlights advances in our understanding of the immunopathogenesis, new and shifting dominant pathogeneses, modern laboratory testing, and use of mechanical circulatory support, with a special emphasis on innovations in cardiac magnetic resonance imaging. Despite these strides forward, we struggle without a universally accepted definition of myocarditis, which impedes progress in disease-targeted therapy.

Original languageEnglish (US)
Pages (from-to)E123-E135
JournalCirculation
DOIs
StateAccepted/In press - 2021

Keywords

  • AHA Scientific Statements
  • heart disease
  • immune system diseases
  • infections
  • inflammation
  • myocarditis
  • pediatrics
  • ventricular dysfunction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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