SAN FRANCISCO — Acute myocarditis and dilated cardiomyopathy should be in the differential diagnosis of any child who presents with difficulty breathing or respiratory symptoms, according to a poster presentation by Dr. Yamini Durani at the annual meeting of the Pediatric Academic Societies.
In a retrospective study of 49 children eventually diagnosed with myocarditis or dilated cardiomyopathy (DCM), Dr. Durani, of Thomas Jefferson University, Philadelphia, and colleagues determined that only 20% were suspected of having one of these disorders at the first visit. The most common initial diagnoses by a physician were respiratory illness (29%) and cardiac disease (29%), followed by viral illness (8%) and other illnesses (33%). The most common primary complaints were difficulty breathing (69%), vomiting (43%), upper respiratory infection (43%), fever (37%), poor feeding (35%), and lethargy (33%).
The investigators acknowledged that respiratory symptoms are extremely common in children, and they don't recommend a cardiac work-up for every child who walks into the office with a cough. They do suggest that physicians keep myocarditis and dilated cardiomyopathy in the differential diagnosis of these children, and that certain subtleties such as hepatomegaly on physical exam or cardiomegaly on chest x-ray may help distinguish these diagnoses from more common respiratory and viral illnesses.
Tachypnea was the most common finding on physical exam, seen in 59% of the patients. Other abnormal signs included hepatomegaly (47%), respiratory distress (43%), and abnormal lung exams (29%).
The American Pediatric Society, Society for Pediatric Research, Ambulatory Pediatric Association, and American Academy of Pediatrics sponsored the meeting.