Inflammatory Heart Diseases in Children
Inflammatory heart diseases include rheumatic fever, Kawasaki disease, and myocarditis. These conditions all stem from an inflammatory process that may lead to significant cardiac morbidity and mortality. These patients often present initially to the emergency department, and prompt recognition and treatment of these conditions are essential. Rheumatic fever is caused by group A streptococcal (GAS) infections and is diagnosed using the Jones criteria. Rheumatic fever may lead to mitral and/or aortic valve dysfunction. Kawasaki disease is a systemic vasculitis that affects medium-sized arteries. Diagnostic criteria include fever, conjunctivitis, mucositis, extremity changes, rash, and lymphadenopathy. Patients may present with shock related to myocarditis and can develop aneurysms in the coronary arteries with the potential for ischemic heart disease. Treatment consists of immunomodulators and anticoagulation. Myocarditis has numerous causes but is most commonly secondary to a viral illness. Clinical presentation varies widely, but patients may present acutely in cardiogenic shock. Treatment consists of immunomodulators and heart failure medications.
KeywordsInflammatory heart disease Rheumatic fever Rheumatic carditis Kawasaki disease Coronary artery aneurysm Myocarditis Cardiomyopathy
- 2.Tani LY. Rheumatic fever and rheumatic heart disease. In: Allen HD, Shaddy RE, Penny DJ, Cetta F, Feltes TF, editors. Moss and Adams’ heart disease in infants, adolescents, and children, including the fetus and young adult. 9th ed. Philadelphia: Wolters Kluwer; 2016. p. 1373–404.Google Scholar
- 4.Newburger JW, Takahashi M, Gerber MA, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Circulation. 2004;110:2747–71.CrossRefGoogle Scholar
- 14.Caforio ALP, Pankuweit S, Arbustini E, et al. Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J. 2013;34:2636–48.CrossRefGoogle Scholar
- 15.Simpson KE, Anwar S, Canter CE. Myocarditis. In: Allen HD, Shaddy RE, Penny DJ, Feltes TF, Cetta F, editors. Moss and Adams’ heart disease in infants, adolescents, and children, including the fetus and young adult. 9th ed. Philadelphia: Wolters Kluwer; 2016. p. 1313–30.Google Scholar