Background: Pediatric myocarditis is rare but challenging. This overview summarized the
current knowledge and recent patents on childhood myocarditis.
Methods: Clinical queries and keywords of “myocarditis” and “childhood” were used as search engine.
Results: Viral infections are the most common causes of acute myocarditis. Affected children often
have a prodrome of fever, malaise, and myalgia. Clinical manifestations of acute myocarditis in children
can be nonspecific. Some children may present with easy fatigability, poor appetite, vomiting,
abdominal pain, exercise intolerance, respiratory distress/tachypnea, dyspnea at rest, orthopnea, chronic
cough with wheezing, chest pain, unexplained tachycardia, hypotension, syncope, and hepatomegaly.
Supraventricular arrhythmias, ventricular arrhythmias, and heart block may be present. A subset of
patients have fulminant myocarditis and present with cardiovascular collapse, which may progress to
severe cardiogenic shock, and even death. A high index of suspicion is crucial to its diagnosis and timely
management. Cardiac magnetic resonance imaging is important in aiding clinical diagnosis while,
endomyocardial biopsy remains the gold standard. The treatment consists of supportive therapy, ranging
from supplemental oxygen and fluid restriction to mechanical circulatory support. Angiotensinconverting
enzyme inhibitors, angio-tensin II receptor blockers, β-blockers, and aldosterone antagonists
might be used for the treatment of heart failure while, immunosuppression treatments remain controversial.
There are a few recent patents targeting prevention or treatment of viral myocarditis, including
an immunogenic composition comprising a PCV-2 antigen, glutathione-S-transferase P1, neuregulins,
NF-[kappa] B inhibitor, a pharmaceutical composition which contains 2-amino-2- (2- (4-octyl phenyl) -
ethyl) propane 1,3-diol, a composition containing pycnojenol, Chinese herbal concoctions, and a Korean
oral rapamycin. Evidence of their efficacy is still lacking.
Conclusion: This article reviews the current literature regarding etiology, clinical manifestations, diagnosis,
and management of acute myocarditis in children.