Podcast 875: A Pediatric Case of Myopericarditis

<p dir="ltr"><strong>Contributor: Meghan Hurley MD</strong></p> <p dir="ltr"><strong>Educational Pearls:</strong></p> <ul> <li dir="ltr" aria-level="1"> <p dir="ltr" role="presentation">Pericarditis is inflammation of the pericardial sac, which can arise from infectious or non-infectious etiologies</p> </li> <li dir="ltr" aria-level="1"> <p dir="ltr" role="presentation">Myocarditis is inflammation of the myocardium, which may accompany pericarditis</p> </li> <li dir="ltr" aria-level="1"> <p dir="ltr" role="presentation">Pericarditis clinical findings include:</p> </li> <ul> <li dir="ltr" aria-level="2"> <p dir="ltr" role="presentation">Diffuse concave ST elevation, classic for acute pericarditis with myocardial involvement. More common in younger male patients</p> </li> <li dir="ltr" aria-level="2"> <p dir="ltr" role="presentation">Elevated high-sensitivity troponin - higher levels may occur in young healthy patients</p> </li> <li dir="ltr" aria-level="2"> <p dir="ltr" role="presentation">Ultrasound may show pericardial effusions</p> </li> </ul> <li dir="ltr" aria-level="1"> <p dir="ltr" role="presentation">POCUS may be helpful in assessing left ventricular ejection fraction (LVEF) via E-point septal separation (EPSS)</p> </li> <ul> <li dir="ltr" aria-level="2"> <p dir="ltr" role="presentation">Elevation in EPSS correlates with decreased LVEF</p> </li> </ul> <li dir="ltr" aria-level="1"> <p dir="ltr" role="presentation">Treatments:</p> </li> <ul> <li dir="ltr" aria-level="2"> <p dir="ltr" role="presentation">Anti-inflammatories including NSAIDs and colchicine</p> </li> <li dir="ltr" aria-level="2"> <p dir="ltr" role="presentation">Monitor inflammation</p> </li> <li dir="ltr" aria-level="2"> <p dir="ltr" role="presentation">Repeat ultrasounds</p> </li> </ul> <li dir="ltr" aria-level="1"> <p dir="ltr" role="presentation">Risk factors in this patient’s case:</p> </li> <ul> <li dir="ltr" aria-level="2"> <p dir="ltr" role="presentation">mRNA COVID vaccine - the risk of myocarditis from vaccination is significantly low