AHA: Pediatric myocarditis often caused by viruses
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Myocarditis in children is most commonly caused by viral infection, although there are a variety of infectious and noninfectious causes, according to a scientific statement from the American Heart Association.
Although work on the statement began before the COVID-19 pandemic, it may be helpful in diagnosing myocarditis caused by COVID-19 infection or by COVID-19 vaccination, the AHA stated in a press release.
‘Potential impact on lifelong health’
“Myocarditis has distinct characteristics in children and a potential impact on their lifelong health,” Yuk M. Law, MD, FAHA, chair of the scientific statement writing group, director of Cardiac Transplant and Heart Failure Service at Seattle Children’s Hospital and professor of pediatrics at the University of Washington School of Medicine in Seattle, said in the release. “We hope that this statement serves as an educational update as well as a unifying call for much needed research to better understand and treat this important pediatric condition. And, in light of the recently recognized occurrence of myocarditis after COVID-19 infection, as well as the emergence of cases of suspected myocarditis after COVID-19 vaccination, this statement is a resource for clinicians and health care professionals in caring for these patients.”
Myocarditis incidence is highest in infants and young adults, Law and colleagues wrote, noting that in children, it is most commonly caused by a viral infection and is usually acute or sudden-onset, and is less likely to be chronic than it is in adults.
The writing group recommended that when active inflammation from myocarditis is present, a child or adolescent should not participate in competitive sports, and should have 24-hour Holter monitoring and exercise stress testing performed at least 3 months after diagnosis and before returning to competition.
The most common symptoms of myocarditis in children are fatigue, shortness of breath, abdominal pain and fever, Law and colleagues wrote, noting that sometimes severe symptoms such as HF, arrhythmias and cardiogenic shock occur. According to the release, the most common symptom of myocarditis caused by a COVID-19 vaccine is chest pain.
None of the most common symptoms are specific to myocarditis and may be a result of other causes, the authors wrote.
Children with acute myocarditis can deteriorate quickly, so it may be reasonable to monitor them in a hospital setting, according to the authors. Early on, patients should be monitored for arrhythmias. In addition, high-risk patients may benefit from mechanical circulatory support, given that myocardial injury may occur, Law and colleagues wrote.
IV immunoglobin and corticosteroids are among the common treatments for pediatric myocarditis, but more evidence is needed to determine the optimal treatment regimens, according to the authors. They also wrote that antiviral therapy can be considered if the cause of the myocarditis is viral.
Myocarditis can also result from Kawasaki disease or rheumatic fever, in which case guidelines for the management of those diseases should be followed, Law and colleagues wrote.
COVID-19 vaccination encouraged
In the release, the AHA and American Stroke Association stated that it “recommends all health care professionals be aware of rare adverse events that may be related to a COVID-19 vaccine including myocarditis. Health care professionals should strongly consider inquiring about the timing of any recent COVID vaccination among patients presenting with symptoms related to cardiovascular conditions, as needed, in order to confirm the diagnosis and to provide appropriate treatment quickly. As indicated by the CDC, we agree that cardiologists should be consulted if myocarditis or any heart-related condition is suspected by a primary care clinician.
“This new scientific statement provides a thorough examination of the latest research on the diagnosis, treatment and follow-up for myocarditis in children prior to the COVID-19 era and confirms that myocarditis is a serious yet uncommon condition in children. The effects of COVID-19 infection include its potentially fatal consequences and the potential long-term health effects that are still revealing themselves, such as conditions affecting the heart including myocarditis, the brain, the vascular system and other organs.
“We remain steadfast in our recommendation for all adults and children ages 12 and older in the U.S. to receive a COVID-19 vaccine as soon as they can receive it, as authorized by the FDA and recommended by the CDC. Overwhelmingly, data continue to indicate that the benefits of COVID-19 vaccination — 91% effective at preventing complications of severe COVID-19 infection including hospitalization and death — far exceed the very rare risks of adverse events, including myocarditis.”
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