title: Update on myocarditis in children.
abstract: OBJECTIVE
  Myocarditis is an uncommon pediatric illness, and it is frequently missed by medical personnel. It often masquerades as more common pediatric illnesses such as respiratory distress or gastrointestinal disease. Given that myocarditis accounts for 12% of sudden cardiac death among adolescents and young adults, the suspicion of this illness in the differential diagnosis of children presenting with nonspecific symptomatology and disease progression can be lifesaving.
  
  
  RESULTS
  Historically, the diagnosis of myocarditis required endomyocardial biopsy. More recently ancillary diagnostic modalities have been used to help make the diagnosis less invasively. The use of laboratory testing, echocardiography, and cardiac MRI can now make the diagnosis in the absence of invasive biopsy and can help improve the diagnostic yield when biopsy is performed. Additionally, with an improved understanding of the pathophysiology of this disease, research has focused on novel therapeutic interventions such as immunoglobulin therapy and immunosuppressive therapy in the care of the patient with myocarditis.
  
  
  CONCLUSIONS
  Myocarditis is a challenging diagnosis to make. With advent of newer diagnostic modalities and an improved understanding of the disease and its progression, there is a genuine hope that outcomes of pediatric myocarditis will be improved. The first step, however, is for medical providers to consider this entity in the differential diagnosis of patients with concerning presentation or illness history.
authors.affiliation: Division of Emergency Medicine, Children's National Medical Center, Washington, District of Columbia 20010, USA. mclevine@cnmc.org
authors.forename: Marla C
authors.initials: MC
authors.lastname: Levine
authors.forename: Darren
authors.initials: D
authors.lastname: Klugman
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Teach
mesh_terms: D001706:Biopsy; D002648:Child; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging; D003955:Diagnostic Tests, Routine; D018450:Disease Progression; D006801:Humans; D009205:Myocarditis / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy