Hostname: page-component-78c5997874-dh8gc Total loading time: 0 Render date: 2024-11-07T02:06:22.054Z Has data issue: false hasContentIssue false

Myopericarditis in children and adolescent: is the elevated troponin and chest pain as alarming as we thought?

Published online by Cambridge University Press:  21 June 2021

Eviç Zeynep Başar*
Affiliation:
Department of Pediatric Cardiology, Kocaeli University, Kocaeli, Turkey
Dilek Borakay
Affiliation:
Department of Pediatric Cardiology, Marmara University, İstanbul, Turkey
Figen Akalın
Affiliation:
Department of Pediatric Cardiology, Marmara University, İstanbul, Turkey
*
Author for correspondence: Dr Eviç Zeynep Akgün, Kocaeli Üniversitesi, Kaboğlu Mahallesi, Umuttepe kampüsü Tıp Fakültesi Hastanesi, Kocaeli, Turkey. Tel: 507 463 00 82. E-mail: [email protected]

Abstract

Aim:

When encountering adolescents with chest pain and a high troponin level but with no underlying coronary artery illness, it is advisable to consider myopericarditis. Though myopericarditis is a self-limiting, benign condition, it nevertheless causes anxiety in the patient and the family.

Methods:

Thirty-nine patients diagnosed with myopericarditis were included. We retrospectively analysed the demographic and clinical features, laboratory tests, echocardiography, electrocardiograms, MRI findings, coronary CT angiography, and conventional angiography findings in these patients.

Results:

Of the 39 patients (female/male = 4/35) aged 7–17 years, 66.6% had viral infection in the 2 weeks preceding presentation. Eleven patients were tested for high-sensitivity cardiac troponin I, 28 for high-sensitivity cardiac troponin T, and 10 patients were tested for both biomarkers. The median hs-TnI and hs-TnT values were 6.3 (0.05–29.9) ng/mL and 586 (51–9398) ng/L, respectively. Twenty-three patients showed ST changes on electrocardiography, of whom 11 had ST-elevation in the leads supporting left ventricular involvement. Coronary CT angiography and catheter angiography evaluations performed for differential diagnosis of coronary anomaly and acute coronary syndrome were normal. Cardiac MRI was conducted on 28 patients, and the results in 10 (35.7%) were suggestive of myopericarditis.

Conclusions:

Myopericarditis is common in the adolescent age group and is generally benign but should be carefully monitored for differential diagnosis and possible complications. Cardiac MRI, which has been used more frequently in recent years, has an important role in differential diagnosis and the follow-up of patients.

Type
Original Article
Copyright
© The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Imazio, M, Cooper, LT. Management of myopericarditis. Expert Rev Cardiovasc Ther 2013; 1: 193201.CrossRefGoogle Scholar
Manda, YR, Baradhi, KM. Myopericarditis. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2020. PMID: 30521197.Google Scholar
Imazio, M, Trinchero, R. Myopericarditis: etiology, management, and prognosis. Int J Cardiol 2008; 127: 1726.10.1016/j.ijcard.2007.10.053CrossRefGoogle Scholar
Kobayashi, D, Aggarwal, S, Kheiwa, A, Shah, N. Myopericarditis in children: elevated troponin I level does not predict outcome. Pediatr Cardiol 2012; 33: 10401045.10.1007/s00246-012-0222-yCrossRefGoogle Scholar
Özyurt, A, Baykan, A, Pamukçu, Ö, et al. Akut Miyo/Perikardit Tanısı Alan 28 Çocuk Hastanın Retrospektif Değerlendirilmesi: Bir Salgının Özellikleri. Turkiye Klinikleri J Med Sci 2013; 33: 11661174.10.5336/medsci.2013-33556CrossRefGoogle Scholar
Sharma, J, Fermandes, N, Alvarez, D, Khanna, S. Acute myopericarditis in an adolescent mimicking acute myocardial infarction. Pediatr Emerg Care 2015; 31: 427430.10.1097/PEC.0000000000000275CrossRefGoogle Scholar
Yoldaş, T, Örün, UA. What is the significance of elevated troponin I in children and adolescents? A diagnostic approach. Pediatr Cardiol 2019; 40: 16381644.CrossRefGoogle ScholarPubMed
Porela, P, Kayto, V, Nikus, K, et al. PR depression is useful in the differential diagnosis of myopericarditis and ST elevation myocardial infarction. Ann Noninvasive Electrocardiol 2012; 17: 141145.10.1111/j.1542-474X.2012.00489.xCrossRefGoogle ScholarPubMed
Imazio, M, Cecchi, E, Demichelis, B, et al. Myopericarditis versus viral or idiopathic acute pericarditis. Heart 2008; 94: 498501.10.1136/hrt.2006.104067CrossRefGoogle ScholarPubMed
Ferreira, ND, Bettencourt, N, Rocha, J, et al. Diagnosis of acute myopericarditis by delayed-enhancement multidetector computed tomography. J Am Coll Cardiol 2012; 60: 868.CrossRefGoogle ScholarPubMed
Takakuwa, KM, Ku, BS, Halpern, EJ. Myopericarditis diagnosed by a 64-slice coronary CT angiography ‘triple rule out’ protocol. Int J Emerg Med. 2010; 3: 447449.CrossRefGoogle Scholar
Lurz, P, Eitel, I, Adam, J, et al. Diagnostic performance of CMR imaging compared with EMB in patients with suspected myocarditis. JACC Cardiovasc Imaging 2012; 5: 513524.10.1016/j.jcmg.2011.11.022CrossRefGoogle ScholarPubMed
American College of Cardiology Foundation Task Force on Expert Consensus Documents, Hundley, WG, Bluemke, DA, Finn, JP, et al. ACCF/ACR/AHA/NASCI/SCMR 2010 expert consensus document on cardiovascular magnetic resonance: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents. J Am Coll Cardiol 2010; 55: 26142662.10.1016/j.jacc.2009.11.011CrossRefGoogle Scholar
Friedrich, MG, Sechtem, U, Schulz-Menger, J, et al. Cardiovascular magnetic resonance in myocarditis: a JACC white paper. J Am Coll Cardiol 2009; 53: 14751487.10.1016/j.jacc.2009.02.007CrossRefGoogle ScholarPubMed
Pelliccia, A, Corrado, D, Bjørnstad, HH, et al. Recommendations for participation in competitive sport and leisure-time physical activity in individuals with cardiomyopathies, myocarditis and pericarditis. Eur J Cardiovasc Prev Rehabil 2006; 13: 876885.10.1097/01.hjr.0000238393.96975.32CrossRefGoogle ScholarPubMed