PMID: 10828777Jun 1, 2000Paper

Viral myocarditis presenting with seizure and electrocardiographic findings of acute myocardial infarction in a 14-month-old child

Annals of Emergency Medicine
R Cunningham, R Silbergleit

Abstract

Acute viral myocarditis is an uncommon but potentially fatal illness in children. Patients with myocarditis may present with nonspecific symptoms or atypical findings that make diagnosis in the emergency department difficult. We describe a previously healthy 14-month-old child with difficulty breathing and a tonic-clonic seizure who was subsequently found to have ECG changes and cardiac marker elevation consistent with acute myocardial infarction. The patient was immediately transferred from our community hospital ED to our tertiary care children's hospital. Shortly after admission, the patient developed intractable nonperfusing ventricular arrhythmias necessitating extracorporeal membrane oxygenation. Cardiac function did not recover, and the patient required heart transplantation before cessation of bypass. Serology and anatomic pathology confirmed coxsackievirus B myocarditis. This case illustrates (1) the nonspecific presentation of myocarditis as dyspnea and seizure, (2) the manner in which myocarditis can mimic myocardial infarction, and (3) the importance of early diagnosis in the ED and transfer to a tertiary care facility.

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Citations

Apr 5, 2003·The Journal of Emergency Medicine·Eric SavitskyScott Votey
Dec 19, 2002·Pediatric Emergency Care·Jane F KnappJonathan I Singer
Jun 28, 2006·Pediatric Emergency Care·Yi-Jung ChangDah-Chin Yan
Dec 29, 2011·CNS Drugs·Ik L Tan, Justin C McArthur
Nov 27, 2010·Emergency Medicine Clinics of North America·Jennifer L MartindaleDaniel J Pallin
Oct 28, 2009·The American Journal of Emergency Medicine·Yamini DuraniAlan L Nager
Mar 21, 2007·Pacing and Clinical Electrophysiology : PACE·John E Madias
Sep 25, 2008·ASAIO Journal : a Peer-reviewed Journal of the American Society for Artificial Internal Organs·Meena NathanJoanne P Starr
Jul 5, 2013·FASEB Journal : Official Publication of the Federation of American Societies for Experimental Biology·Katja SteinkeGuiscard Seebohm

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