{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T19:11:52Z","timestamp":1790709112748,"version":"4.1.0"},"reference-count":35,"publisher":"American Academy of Pediatrics (AAP)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2007,12,1]]},"abstract":"<jats:p>OBJECTIVE. The goal was to determine, in children with myocarditis, the frequency of various presenting symptoms and the sensitivity of clinical and laboratory investigations routinely available in the emergency department.<\/jats:p>\n                  <jats:p>METHODS. We performed a retrospective review of all patients &amp;lt;18 years of age who were diagnosed as having myocarditis at our institution between May 2000 and May 2006 and who initially presented to an emergency department. Patients were categorized as having definite myocarditis (positive endomyocardial biopsy results) or probable myocarditis(diagnosis assigned by a pediatric cardiologist on the basis of history, physical examination, and investigation results in the absence of an endomyocardial biopsy or in the presence of negative biopsy results). All patients were assigned a predominant category of symptoms at presentation on the basis of criteria defined a priori.<\/jats:p>\n                  <jats:p>RESULTS. There were 16 cases of definite myocarditis and 15 cases of probable myocarditis. The age distribution was nonnormal, with peaks among children \u22643 years and \u226516 years of age. Of 14 patients who were seen by a physician before being diagnosed with myocarditis, 57% were originally diagnosed as having pneumonia or asthma. Thirty-two percent of patients presented with predominantly respiratory symptoms, 29% had cardiac symptoms, and 6% had gastrointestinal symptoms. Although evidence of cardiac dysfunction was frequently present in the form of respiratory distress, only a minority of children had evidence of hepatomegaly or abnormal cardiac examination results. The sensitivities of electrocardiograms and chest radiographs as screening tests were 93% and 55%, respectively. Among laboratory tests studied, aspartate aminotransferase measurement was the most sensitive (sensitivity: 85%).<\/jats:p>\n                  <jats:p>CONCLUSIONS. Children with myocarditis present with symptoms that can be mistaken for other types of illnesses; respiratory presentations were most common. When clinical suspicion of myocarditis exists, chest radiography alone is an insufficient screening test. All children should undergo electrocardiography. Aspartate aminotransferase testing may be a useful adjunctive investigation.<\/jats:p>","DOI":"10.1542\/peds.2007-1073","type":"journal-article","created":{"date-parts":[[2007,11,30]],"date-time":"2007-11-30T12:33:39Z","timestamp":1196426019000},"page":"1278-1285","source":"Crossref","is-referenced-by-count":149,"title":["Pediatric Myocarditis: Emergency Department Clinical Findings and Diagnostic Evaluation"],"prefix":"10.1542","volume":"120","author":[{"given":"Stephen B.","family":"Freedman","sequence":"first","affiliation":[{"name":"Divisions of Pediatric Emergency Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. Kimberly","family":"Haladyn","sequence":"additional","affiliation":[{"name":"Divisions of Pediatric Emergency Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alejandro","family":"Floh","sequence":"additional","affiliation":[{"name":"Cardiology"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joel A.","family":"Kirsh","sequence":"additional","affiliation":[{"name":"Cardiology"},{"name":"Department of Critical Care Medicine, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Glenn","family":"Taylor","sequence":"additional","affiliation":[{"name":"Pathology"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Thull-Freedman","sequence":"additional","affiliation":[{"name":"Divisions of Pediatric Emergency Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2007,12,1]]},"reference":[{"key":"2021120902002587300_R1","doi-asserted-by":"crossref","unstructured":"Towbin JA, Lowe AM, Colan SD, et al. Incidence, causes, and outcomes of dilated cardiomyopathy in children. JAMA.\u20082006;296:1867\u20131876","DOI":"10.1001\/jama.296.15.1867"},{"key":"2021120902002587300_R2","doi-asserted-by":"crossref","unstructured":"Feldman AM, McNamara D. Myocarditis. N Engl J Med.\u20082000;343:1388\u20131398","DOI":"10.1056\/NEJM200011093431908"},{"key":"2021120902002587300_R3","doi-asserted-by":"crossref","unstructured":"Chang YJ, Chao HC, Hsia SH, Yan DC. Myocarditis presenting as gastritis in children. Pediatr Emerg Care.\u20082006;22:439\u2013440","DOI":"10.1097\/01.pec.0000221346.64991.e7"},{"key":"2021120902002587300_R4","doi-asserted-by":"crossref","unstructured":"Bohn D, Benson L. Diagnosis and management of pediatric myocarditis. Paediatr Drugs.\u20082002;4:171\u2013181","DOI":"10.2165\/00128072-200204030-00004"},{"key":"2021120902002587300_R5","doi-asserted-by":"crossref","unstructured":"Levi D, Alejos J. Diagnosis and treatment of pediatric viral myocarditis. Curr Opin Cardiol.\u20082001;16:77\u201383","DOI":"10.1097\/00001573-200103000-00001"},{"key":"2021120902002587300_R6","doi-asserted-by":"crossref","unstructured":"Kotilainen P, Lehtopolku M, Hakanen AJ. Myopericarditis in a patient with Campylobacter enteritis: a case report and literature review. Scand J Infect Dis.\u20082006;38:549\u2013552","DOI":"10.1080\/00365540500372903"},{"key":"2021120902002587300_R7","unstructured":"Dancea AB. Myocarditis in infants and children: a review for the paediatrician. J Paediatr Child Health.\u20082001;343:1388\u20131398"},{"key":"2021120902002587300_R8","doi-asserted-by":"crossref","unstructured":"Drucker NA, Colan SD, Lewis AB, et al. \u03b3-Globulin treatment of acute myocarditis in the pediatric population. Circulation.\u20081994;89:252\u2013257","DOI":"10.1161\/01.CIR.89.1.252"},{"key":"2021120902002587300_R9","doi-asserted-by":"crossref","unstructured":"Press S, Lipkind RS. Acute myocarditis in infants: initial presentation. Clin Pediatr (Phila).\u20081990;29:73\u201376","DOI":"10.1177\/000992289002900202"},{"key":"2021120902002587300_R10","doi-asserted-by":"crossref","unstructured":"Drucker NA, Newburger JW. Viral myocarditis: diagnosis and management. Adv Pediatr.\u20081997;44:141\u2013171","DOI":"10.1016\/S0065-3101(24)00051-3"},{"key":"2021120902002587300_R11","doi-asserted-by":"crossref","unstructured":"Checchia PA, Kulik TJ. Acute viral myocarditis: diagnosis. Pediatr Crit Care Med.\u20082006;7(suppl):S8\u2013S11","DOI":"10.1097\/01.PCC.0000244336.60719.8C"},{"key":"2021120902002587300_R12","unstructured":"Aretz HT, Billingham ME, Edwards WD, et al. Myocarditis: a histopathologic definition and classification. Am J Cardiovasc Pathol.\u20081987;1:3\u201314"},{"key":"2021120902002587300_R13","doi-asserted-by":"crossref","unstructured":"Batra AS, Lewis AB. Acute myocarditis. Curr Opin Pediatr.\u20082001;13:234\u2013239","DOI":"10.1097\/00008480-200106000-00004"},{"key":"2021120902002587300_R14","doi-asserted-by":"crossref","unstructured":"Grenier MA, Osganian SK, Cox GF, et al. Design and implementation of the North American Pediatric Cardiomyopathy Registry. Am Heart J.\u20082000;139:S86\u2013S95","DOI":"10.1067\/mhj.2000.103933"},{"key":"2021120902002587300_R15","doi-asserted-by":"crossref","unstructured":"Mason JW, O'Connell JB, Herskowitz A, et al. A clinical trial of immunosuppressive therapy for myocarditis: the Myocarditis Treatment Trial Investigators. N Engl J Med.\u20081995;333:269\u2013275","DOI":"10.1056\/NEJM199508033330501"},{"key":"2021120902002587300_R16","unstructured":"Robertson J, Shilkofski N, eds. Harriet Lane Handbook: A Manual for Pediatric House Officers. 17th ed. Philadelphia, PA: Mosby; 2005"},{"key":"2021120902002587300_R17","unstructured":"Fleisher GR, Ludwig S, Henretig FM, Ruddy RM, Silverman BK, eds. Textbook of Pediatric Emergency Medicine. 5th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2005"},{"key":"2021120902002587300_R18","doi-asserted-by":"crossref","unstructured":"Singer JI, Isaacman DJ, Bell LM. The wheezer that wasn't. Pediatr Emerg Care.\u20081992;8:107\u2013109","DOI":"10.1097\/00006565-199204000-00017"},{"key":"2021120902002587300_R19","doi-asserted-by":"crossref","unstructured":"Alpern ER, Stevens MW. An offbeat wheezer. Pediatr Ann.\u20082000;29:97\u2013101","DOI":"10.3928\/0090-4481-20000201-09"},{"key":"2021120902002587300_R20","doi-asserted-by":"crossref","unstructured":"Mahrholdt H, Wagner A, Deluigi CC, et al. Presentation, patterns of myocardial damage, and clinical course of viral myocarditis. Circulation.\u20082006;114:1581\u20131590","DOI":"10.1161\/CIRCULATIONAHA.105.606509"},{"key":"2021120902002587300_R21","doi-asserted-by":"crossref","unstructured":"Rubenstein JS, Noah ZL, Zales VR, Shulman ST. Acute myocarditis associated with Shigella sonnei gastroenteritis. J Pediatr.\u20081993;122:82\u201384","DOI":"10.1016\/S0022-3476(05)83492-4"},{"key":"2021120902002587300_R22","doi-asserted-by":"crossref","unstructured":"Grech V, Calvagna V, Falzon A, Mifsud A. Fatal, rotavirus-associated myocarditis and pneumonitis in a 2-year-old boy. Ann Trop Paediatr.\u20082001;21:147\u2013148","DOI":"10.1080\/02724930120058214"},{"key":"2021120902002587300_R23","doi-asserted-by":"crossref","unstructured":"Trompeter M, Brazda T, Remy CT, Vestring T, Reimer P. Non-occlusive mesenteric ischemia: etiology, diagnosis, and interventional therapy. Eur Radiol.\u20082002;12:1179\u20131187","DOI":"10.1007\/s00330-001-1220-2"},{"key":"2021120902002587300_R24","doi-asserted-by":"crossref","unstructured":"Uzoigwe C. Campylobacter infections of the pericardium and myocardium. Clin Microbiol Infect.\u20082005;11:253\u2013255","DOI":"10.1111\/j.1469-0691.2004.01028.x"},{"key":"2021120902002587300_R25","doi-asserted-by":"crossref","unstructured":"Selbst SM. Consultation with the specialist: chest pain in children. Pediatr Rev.\u20081997;18:169\u2013173","DOI":"10.1542\/pir.18-5-169"},{"key":"2021120902002587300_R26","doi-asserted-by":"crossref","unstructured":"Massin MM, Bourguignont A, Coremans C, Comte L, Lepage P, Gerard P. Chest pain in pediatric patients presenting to an emergency department or to a cardiac clinic. Clin Pediatr (Phila).\u20082004;43:231\u2013238","DOI":"10.1177\/000992280404300304"},{"key":"2021120902002587300_R27","doi-asserted-by":"crossref","unstructured":"Selbst SM, Ruddy RM, Clark BJ, Henretig FM, Santulli T Jr. Pediatric chest pain: a prospective study. Pediatrics.\u20081988;82:319\u2013323","DOI":"10.1542\/peds.82.3.319"},{"key":"2021120902002587300_R28","unstructured":"Keith JD, Rowe RD, Vlad P, eds. Heart Disease in Infancy and Childhood. New York, NY: Macmillan; 1978"},{"key":"2021120902002587300_R29","unstructured":"Wu JM, Wang JN, Lin CS, Lee WL. Trifascicular block with intermittent complete atrioventricular block in a child. J Formos Med Assoc.\u20081997;96:921\u2013924"},{"key":"2021120902002587300_R30","doi-asserted-by":"crossref","unstructured":"Greenwood RD, Nadas AS, Fyler DC. The clinical course of primary myocardial disease in infants and children. Am Heart J.\u20081976;92:549\u2013560","DOI":"10.1016\/S0002-8703(76)80074-9"},{"key":"2021120902002587300_R31","doi-asserted-by":"crossref","unstructured":"Lauer B, Niederau C, Kuhl U, et al. Cardiac troponin T in patients with clinically suspected myocarditis. J Am Coll Cardiol.\u20081997;30:1354\u20131359","DOI":"10.1016\/S0735-1097(97)00317-3"},{"key":"2021120902002587300_R32","doi-asserted-by":"crossref","unstructured":"Soongswang J, Durongpisitkul K, Nana A, et al. Cardiac troponin T: a marker in the diagnosis of acute myocarditis in children. Pediatr Cardiol.\u20082005;26:45\u201349","DOI":"10.1007\/s00246-004-0677-6"},{"key":"2021120902002587300_R33","doi-asserted-by":"crossref","unstructured":"Naschitz JE, Slobodin G, Lewis RJ, Zuckerman E, Yeshurun D. Heart diseases affecting the liver and liver diseases affecting the heart. Am Heart J.\u20082000;140:111\u2013120","DOI":"10.1067\/mhj.2000.107177"},{"key":"2021120902002587300_R34","unstructured":"Kanda T, Kobayashi I, Suzuki T, Murata K, Radio SJ, McManus BM. Elevation of ALT to AST ratio in patients with enteroviral myocarditis. J Med.\u20081995;26:153\u2013162"},{"key":"2021120902002587300_R35","doi-asserted-by":"crossref","unstructured":"Cox GF, Sleeper LA, Lowe AM, et al. Factors associated with establishing a causal diagnosis for children with cardiomyopathy. Pediatrics.\u20082006;118:1519\u20131531","DOI":"10.1542\/peds.2006-0163"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/120\/6\/1278\/1175040\/zpe01207001278.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/120\/6\/1278\/1175040\/zpe01207001278.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,2,19]],"date-time":"2024-02-19T17:14:25Z","timestamp":1708362865000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/120\/6\/1278\/70582\/Pediatric-Myocarditis-Emergency-Department"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2007,12,1]]},"references-count":35,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2007,12,1]]},"published-print":{"date-parts":[[2007,12,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2007-1073","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2007,12,1]]}}}