Hanoi National Children's Hospital received a number of children with critical acute myocarditis, but the initial symptoms were similar to fever and common flu, causing parents to be subjective.
A 4-year-old girl with abdominal pain, fever, and vomiting was taken to the National Children's Hospital by her parents on August 3. There, the child was very tired and her lips were pale, so the doctor ordered monitoring and an echocardiogram, which discovered abnormal heart function.
The results showed that the child's heart function was severely reduced, had an arrhythmia, and high cardiac enzyme levels, indicating acute myocarditis with cardiogenic shock. The doctors consulted and decided to place an ECMO machine (artificial heart-lung machine) to support the heart, which was contracting weakly and had severe arrhythmia.
On August 13, Master, Doctor Tran Ba Dung, Department of Internal Medicine Intensive Care, said that after 5 days of using ECMO, combined with drugs, the baby's condition gradually improved. Currently, the child has been weaned off ECMO and ventilator, is still breathing oxygen, and vital functions are stable. However, the child still needs to be monitored for cardiac recovery and comply with regular check-ups.
Lying in the bed next to her, a 13-year-old girl was also experiencing the same condition. 10 days ago, the child had a sore throat, dry cough, stomachache, and nausea. The parents subjectively bought medicine to treat the condition at home, but the child became increasingly tired. When she was examined at the National Children's Hospital, she had symptoms of rapid breathing, rapid heart rate, and low blood pressure.
Immediately, the child was given cardioversion, cardiac medications, antiarrhythmics, and an endotracheal tube. After a multidisciplinary consultation, the doctors diagnosed the child with cardiogenic shock and acute myocarditis, prescribed mechanical ventilation, and placed on ECMO for 5 days. Currently, the child is breathing on his own, has no neurological sequelae, and has a good prognosis for recovery, but still needs long-term cardiovascular monitoring.
Doctor examines a child with myocarditis. Photo: Provided by the hospital
Myocarditis is an inflammation and necrosis of heart muscle cells. There are many causes of myocarditis in children such as infection (virus, bacteria, fungus); poisoning; some autoimmune diseases (Lupus, Kawasaki) or hypersensitivity to some drugs. The rate of myocarditis in children is about 1-2/100,000. At the National Children's Hospital, on average, every year about 15 children with acute myocarditis (with cardiogenic shock) are admitted to the Internal Medicine Intensive Care Department.
MSc. Dr. Luong Minh Canh, Cardiovascular Center, said the signs of the disease are often atypical, about half of children show signs of viral infection a few weeks before the onset of the disease. After that, the child may experience fatigue, abdominal pain, nausea, vomiting, diarrhea, fever, and cough.
"However, if the child has other symptoms such as rapid breathing, chest pain, difficulty breathing, rapid heartbeat, pale lips and skin..., they should be taken to the hospital immediately," Dr. Canh recommended.
Symptoms of myocarditis in children are diverse and non-specific, so early diagnosis of the disease also poses many challenges for clinicians. Previously, the mortality rate of children with acute myocarditis was very high, but now thanks to interdisciplinary coordination and ECMO machines, many children have been saved. According to research by the Department of Internal Medicine Intensive Care, the survival rate of children with myocarditis supported by ECMO is about 60%.
Most children with acute myocarditis will recover completely, but this group should limit strenuous exercise and avoid participating in competitive sports for about 3-6 months. Children also need to be monitored and re-examined periodically according to the doctor's instructions.
Le Nga
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