Aggiornamento
Miocardite: la grande simulatrice
Myocarditis: the great pretender
Elisa Benelli1, Meta Starc1, Emanuela Berton2, Marco Anzini3, Alessandra Benettoni2, Alessandro Ventura1, Gianfranco Sinagra3
1Clinica Pediatrica, IRCCS Materno-Infantile “Burlo Garofolo”, Università di Trieste
2SS DPT Cardiologia, IRCCS Materno-Infantile “Burlo Garofolo”, Trieste
3Dipartimento Cardiovascolare, “Ospedali Riuniti”, Università di Trieste
Settembre 2013 - pagg. 429 -434
Abstract
Myocarditis is a rare, but life threatening disease in childhood. It is most often due to common
viral infections; less commonly, it may result from bacterial infections, immune mediated
diseases or chemotherapy. Myocarditis may present with unspecific symptoms, ranging
from respiratory to gastrointestinal ones; a clear hypomobility is the typical sign of myocarditis
(“the immobile child”). The diagnosis is based on electrocardiogram and echocardiography,
which are always pathologic but unspecific; an X-chest is useful to identify cardiomegaly.
Among laboratory tests, the most sensitive element is an increased level of aspartate
aminotransferase, while troponin dosage has low specificity and not absolute sensitivity.
Endomyocardial biopsy is the gold standard diagnostic test, but it should be performed
only in patients who do not respond to usual treatment, because of the high risk of
side effects. The mainstay of therapy is supportive therapy for left ventricular dysfunction.
The fulminant viral forms usually have initial significant cardiovascular impairment, followed
by a complete resolution. On the other hand, a subacute disease might have less initial cardiovascular
impairment, but more often can evolve to chronic dilated cardiomyopathy. In
this case immunosuppressive therapy could be useful.
Classificazione MeSH
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Corrispondenza: elisa.benelli@gmail.com