173 Cardiac biomarkers in diagnosing acute myocarditis in adolescents

• Published in: Archives of disease in childhood Vol. 106; no. Suppl 2; pp. A73 - A74
• Main Authors: Maria, Jurac Ruxandra, Doros, G, Ardelean, AM, Olariu, C, Isac, R, Stroescu, R, Gafencu, M, Popoiu, A, Blescun, A, Stoica-Iakab, A, Murariu, M, Jurac, R
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health 11.10.2021; BMJ Publishing Group LTD
• Subjects: Abstracts; Adolescents; Biomarkers; Bradycardia; Calcium-binding protein; Cardiac muscle; Cytomegalovirus; Diuretics; Echocardiography; EKG; Gadolinium; Heart attacks; Heart diseases; Immobilization; Inflammation; Magnetic resonance imaging; Medical diagnosis; Mimicry; Myocardial infarction; Myocarditis; Pain; Parvoviruses; Patients; Pediatrics; Serology; Teenagers; Thrombophilia; Troponin; Troponin I; Troponin T; Vitamins
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/archdischild-2021-europaediatrics.173

AimTo present a cohort of adolescents admitted into our clinic for precordial pain, mimicking myocardial infarction. Cardiac biomarkers were crucial in diagnosing and monitoring acute myocarditis.Material and MethodsDuring a two year interval, a number of 6 adolescent males were admitted in the ED with severe precordial pain. All were between14-17 yo. They performed lab investigations, ECG, Echocardiography, Speckle-tracking, Holter ECG and cardiac biomarkers. Two were explored by angiocoronarography due to acute STEMI aspect on ECG, to exclude myocardial infarction. Angio MRI of the heart performed in all patients.ResultsSix males were admitted for severe precordial pain, 8 on a scale of 0-10, which appeared within the last 12 hours, with a duration of 1-2 hours, accompanied by palpitations. One boy had Duchenne disease and one thrombophilia. The CRP was slightly elevated in all cases, with values between 7 and 56 mg/dl; hsCRP was also elevated. CPK was increased in all cases, varying between 134 – 1834 ng/ml. The highest value was in Duchene patient. CPK-MB was slightly increased in 4 patients and very increased in two. Troponin T was positive in two patients with values 54 and 51 pg/ml and increased values in four, between 669 and 2500 pg/ml. Troponin I had very high values, from 501 to 30.000 pg/ml in one case of multifocal myocarditis.NTproBNP was altered in all patients, with values between 72 and 1508 pg/ml.TGO and TGP were elevated, especially TGO. ECG in all cases had the aspect of acute STEMI. Two cases were explored by angiocoronarography with negative result. Ejection fraction was at the lower limit of normal in 3 cases and reduced between 45-49% in the other three. Speckle-tracking was significant in all 6 cases. Holter ECG detected PVC in 2 cases and bradycardia in one.Cardiac MRI revealed inflamed heart muscle at late gadolinium enhancement.MRI was repeated at 6 mo and 1 year after, with good results. Viral serology was negative for: parvovirus, coxackie, adenovirus, cytomegalovirus.Treatment included: AINS, Carvedilol, diuretic, vitamins, bed rest until troponin normalization and sport avoidance 6 mo to 1 year.ConclusionsMyocarditis in adolescents almost always mimics myocardial infarction. Cardiac biomarkers help in the diagnosis, evolution and follow-up. Troponin I is more accurate than troponin T. The extremely high values of Troponin I was correlated with severe acute multifocal myocarditis. Cardiac MRI with late gadolinium enhancement is the hallmark of myocarditis.