title: Direct cardiac involvement in childhood hemolytic-uremic syndrome: case report and review of the literature.
abstract: Overhydration, hypertension, anemia, or dyselectrolytemias sometimes cause cardiovascular impairment in childhood hemolytic-uremic syndrome. Here, we report the case of a 4.5-year-old boy with hemolytic-uremic syndrome and sudden onset, 6 h later, of hemodynamic compromise secondary to a cardiac thrombotic micro-angiopathy. The child died. In the literature, we found 18 further cases with cardiac compromise ≤25 days after diagnosis. The following causes were found: micro-angiopathy, pericardial blood causing tamponade, and myocarditis.
  
  
  CONCLUSIONS
  We were able to document only 19 cases of childhood hemolytic-uremic syndrome complicated by a direct cardiac compromise. Nonetheless, we speculate that a direct cardiac compromise accounts for many cases of childhood hemolytic-uremic syndrome complicated by sudden death during the initial hospitalization. Hence, we propose to always measure troponin in children with hemolytic-uremic syndrome to detect a latent myocardial damage. What is Known: • Overhydration, hypertension, anemia, or dyselectrolytemias sometimes cause cardiovascular impairment in childhood hemolytic-uremic syndrome. What is New: • This study documents 19 cases of childhood hemolytic-uremic syndrome complicated by a direct cardiac compromise ≤ 25 days after diagnosis. • The Following causes were found: micro-angiopathy, pericardial blood causing tamponade, and myocarditis.
authors.affiliation: Pediatric Department of Southern Switzerland, Via Ospedale, CH-6500, Bellinzona, Switzerland.
authors.forename: Davide
authors.initials: D
authors.lastname: Rigamonti
authors.affiliation: Pediatric Department of Southern Switzerland, Via Ospedale, CH-6500, Bellinzona, Switzerland. giacomo.simonetti@eoc.ch.|Division of Pediatric Nephrology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 15, CH-3010, Bern, Switzerland. giacomo.simonetti@eoc.ch.
authors.forename: Giacomo D
authors.initials: GD
authors.lastname: Simonetti
mesh_terms: D000208:Acute Disease; D002675:Child, Preschool; D004452:Echocardiography; D017809:Fatal Outcome; D006333:Heart Failure / Q000209:etiology*; D006463:Hemolytic-Uremic Syndrome / Q000150:complications* / Q000175:diagnosis*; D006801:Humans; D008297:Male; D014336:Troponin / Q000097:blood
chemical_list: D014336:Troponin
keywords: Acute myocardial infarction; Acute renal failure; Heart failure; Hemolytic-uremic syndrome; Thrombotic micro-angiopathy; Troponin