Aziz KU.
Acute Myocarditis in children, incidence, treatment and prognosis: A developing world problem.
Pak Paed Cardiol J Jan ;3(1-2):24-9.

We analysed our experience with AM at the National Institute of Cardiovascular Diseases at Karachi in children less than 12-year age seen during 1981-1999. The diagnosis was based on echocardiographic detection of left ventricular dysfunction due to no apparent cause. Four hundred and six children had a diagnosis of left ventricular dysfunction on echocardiography, but the chart of 151 children were available for analysis of features on clinical, echocardiographic, ECG, xray chest examinations and the out come on follow up was determined. All children with specific infections were excluded. Eighteen (11.9%) were infants less than 12 month age (mean 8.0±3.9 months) and 131(86.8%) were a mean of 6.9±3 year age. Follow up period was less tan 3 months in 12 (mean 2.1±0.8 months) and greater than 4 (mean 29.3±11.8 months) in 63 children and two were seen for 3.5 and 13 years. Forty-six of 151 (30.1%) were lost to follow-up after discharge from the hospital. There was in creased seasonal incidence to admission between January to April. Clinical presentation was char acterised by febrile illness and congestive heart failure, cardiomegaly, low voltage ECG, general ised ST -T changes, Prolonged QTc of greater than 0.45 and left atrial hypertrophy. Echocardiograms showed. generalised left ventricular dysfunction with mean ejection fraction of (EF) 28±12%. Out come analysis showed (30.5%) lost to follow up, 23.3% died, 25.9% were cured with EF fraction increasing from 31.8±12% to 78±10%. Sixteen remained in compensated CHF, 41 were in chronic decompensated state. Steroids were administered to 20 children with disease of more than 3 months, 9 achieved normal EF. In conclusion our study showed that AM is common in Pakistan and is responsible for significant mortality and morbidity in children. Steroids when given after 3 month of disease can affect cure in significant number of children.

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