Muhammad Younas, Ahsan Waheed Rathore, Masood Sadiq.
Acute Myocarditis - the commonest cause of cardiac failure in children.
Pak Paed J Jan ;27(2):63-7.

Background: In the West congenital heart defects are the commonest cause of heart failure in infancy and early childhood. There is an observation that acute myocardial dilatation and dysfunction most likely due to myocarditis is very common in our part of the world and an important cause of heart failure in children. Objective: Report our experience of heart failure in infancy and childhood, evaluating its causes, clinical pattern and determine outcome. Setting: A tertiary referral center for general paediatrics. Patients and methods: A prospective observational study on children admitted to a single center with heart failure from January 1997 to September 1997. The diagnosis was based on clinical manifestations, ECG, chest X-ray and echocardiography. The diagnosis of congenital heart defects (CHID) was confirmed on echocardiography. The diagnosis of myocarditis was clinical with verification of myocardial dilatation and dysfunction on echocardiography. Results: Fifty patients with clinical presentation of heart failure were studied, excluding neonates. Patients were arbitrarily divided into three age groups as 0.1-1 year, 1-3 years and 3-5 years. Acute myocarditis was the most common cause present in 24 (48%) patients. Sixteen patients CHID (32%), 11 (22%) with ventricular septal defect, 3 (6%) transposition of great arteries, one total anomalous pulmonary venous drainage and one patent ductus arteriosus. Seven (14%) were diagnosed as dilated cardiomyopathy and 2 (4%) children had severe anemia (b - thalassemia & ALL). One child had constrictive pericarditis most likely secondary to tuberculosis. None of the patients had rheumatic heart disease. Of 24 patients with acute myocarditis, 9 died (37.5%), 6 within 48 hours of admission. Over all mortality was 26% (13 patients). Conclusions: Acute myocarditis is the commonest cause of heart failure in infants and children under 5 years of age and carries a high mortality. Among congenital heart defects, VSD is the commonest defect presenting with heart failure in less than one year age group.

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