Pericarditis in children

Pericarditis is an inflammation or infection of the pericardium, which is a thin sac (membrane) surrounding the heart. Normally, there is a small amount of fluid between the inner and outer layers of the pericardium, but in diseases of the type of pericardial effusion, its volume increases. This can lead to a life-threatening complication - cardiac tamponade.

In a large database on the study of hospitalized pediatric patients with pericarditis and pericardial effusions, the main factors of development were identified: after cardiac surgery (54%), neoplasia (13%), renal (13%), idiopathic or viral pericarditis (5%) and rheumatological diseases (5%) (Shakti D, Hehn R, Gauvreau K, Sundel RP, Newburger JW. Idiopathic pericarditis and effusion in the pericardium in children: modern epidemiology and treatment. Journal of the American Heart Association 2014).

Pediatric pericarditis in the emergency department is also more likely to be secondary to postcardiac surgery or due to systemic illness. Still, idiopathic or viral pericarditis is more common.

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Description of pericarditis in children

Pericarditis is an inflammation, infectious or non-infectious, of the pericardial sac. The pericardium consists of 2 thin layers, visceral and parietal, which surround the heart. Usually there is a small amount of fluid between the layers of the pericardium. When it becomes inflamed, the amount of fluid may increase. This is called pericardial effusion. If the amount of fluid increases rapidly, then there may be a risk of heart failure due to the pericardial tamponade developed.

Causes of pericarditis in children

In children, pericarditis most often develops after surgery to eliminate heart defects (congenital or acquired). Other causes of pericarditis in children are as follows:

• Viral or bacterial infection.
• Autoimmune disorders such as systemic lupus erythematosus or rheumatoid arthritis.
• Traumatic lesion.
• Incorrect use of certain medications.
• Oncological diseases.

Infectious purulent pericarditis in children often develops due to such microorganisms as Staphylococcus aureus, Haemophilus influenzae, Neisseria meningitidis, Streptococcus pneumoniae. Gram negative intestinal sticks, Pseudomonas aeruginosa, some types of Salmonella (including S typhi and S typhimurium), Francisella tularensis, anaerobic bacteria, fungi (Histoplasma, Acetomama, Icephalitis, fungi (Histoplasma, Acetabaloma, Acetabaloma, Fungus tomorrhagia), anaerobic bacteria; , as well as mycobacterium tuberculosis.

In 40% -80% of cases, bacterial pericarditis in children is caused by Streptococcus aureus.

Pericarditis in children: symptoms

There are a group of the most common symptoms of pericarditis in children:

• Chest pain, often described as sharp or stabbing.
• Fever.
• Arrhythmia (disturbed heart rhythm).
• Confused breathing.
• Heartbeat (rapid heartbeat).
• Fainting or severe dizziness.

Children may not be able to give an accurate description of what a chest pain is. Also, babies cannot explain how they feel. In such cases, the child may be irritable, have no appetite, or be tired. In such situations, small children are capricious, it would seem, for no reason.

Symptoms of pericarditis may be similar to other diseases. Therefore, it is important that the child be examined by a doctor for a definitive diagnosis.

Diagnosis of pericarditis in children

At the doctor's office, questions will be asked about the child's symptoms and medical history. During a medical examination, you listen to your baby’s heart with a stethoscope, in which abnormal heart sounds, called pericardial friction noise, can be heard. Friction is an abnormal sound caused by the deposition of pathological lesions on the pericardial sheets.

To confirm the diagnosis of pericarditis, the child may need the following tests:

• Laboratory tests : complete blood count (PAK) and other studies to check for the presence of inflammation and infection in the body.
• Chest X-ray : A heart and lung X-ray is performed that helps to determine the heart boundaries and the severity of the pulmonary pattern. With pericarditis, the boundaries will be increased, and in the case of pneumonia, the pulmonary pattern is enhanced, and the affected lung lobe is darkened.
• Electrocardiography (ECG) : the simplest and safest diagnostic method, during which the electrical activity of the heart is checked. When pericarditis on the electrocardiogram visible changes.
• Echocardiography (echoCG) . The operation of this test is based on the use of sound waves (ultrasound), resulting in moving images of the heart and heart valves.

In extreme cases, computed tomography (CT) or magnetic resonance imaging (MRI) may be performed. These are visual tests that show the structure and function of the heart, but because of their harmfulness, they are rarely used.

Pericarditis in children: treatment

The attending physician of the child is likely to give a referral to a pediatric cardiologist. This is a doctor with special training for treating children with heart and vascular problems.

The goal of pericarditis treatment is to identify and eliminate the cause of the disease. Also used methods to reduce the severity of symptoms. Treatment of pericarditis in children may include:

• Drug therapy . Medicines can relieve pain and reduce the severity of inflammation. In particular, antibiotics are used to treat infections caused by bacteria. If necessary, use drugs that normalize the rhythm of the heart or strengthen its work.
• Removal (aspiration) of excess fluid from the pericardium (pericardiocentesis). Allows you to make room for the full work of the heart muscle and, if necessary, look at the fluid to determine the cause of pericarditis.
• Surgical intervention. In particular, with constrictive pericarditis, part of the pericardium can be removed (pericardiectomy).

The European Society of Cardiology (ESC) recommends using high doses of NSAIDs as first-line therapy for pericarditis in children, and with colchicine as second-line therapy (Adler Y., Charron P. et al. 2015 ESC Guidelines for the Diagnosis and Treatment of Pericardial Diseases : European Society of Cardiology (ESC) Task Force for the Diagnosis and Treatment of Pericardial Disorders Approved by: European Association of Cardiothoracic Surgery (EACTS) (European Cardiology Journal 2015).

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Possible complications of pericarditis in children

Under adverse conditions, pericarditis may recur (recur) or continue for a long time, that is, become chronic. In severe cases, the complication develops into a life-threatening problem - cardiac tamponade.

Heart tamponade may develop due to any reason for the accumulation of acute fluid in the pericardial cavity. Severe tamponade can cause cardiac arrest due to electromechanical dissociation. Less serious cases can lead to tachycardia, tachypnea, lower blood pressure (BP), increased central venous pressure and paradoxical pulse. Often, patients report shortness of breath and severe chest pain.

When should I call a medical professional about a sick child? You should call your doctor if your child’s symptoms worsen, severe chest pain, or breathing problems.

Key points

• Pericarditis is an inflammation or infection of the lining of the heart.
• Pericarditis is most often caused by infection, in particular bacterial.
• Chest pain is the most common symptom of pericarditis.
• A child, especially a small one, can be irritable, have a poor diet, or often be tired without any reason.
• Pericarditis treatment is based on the use of drugs for inflammation and pain.
• Antibiotics are most often used for infectious bacterial pericarditis.

Tips to help make medical care visits as effective as possible:

1. It is important to know the reason for the visit and what I want to receive as a result.
2. Before visiting the doctor, you need to write down questions that you want to get answers to.
3. During the visit, you should record the name of the diagnosis and the medicines, treatments or tests that the doctor prescribed. It is also important to write down all the instructions and recommendations given by the doctor.
4. One should ask why this particular medicine or method of treatment is prescribed to the child and how they can help him.It is also necessary to know the possible side effects.
5. Alternatively, you can ask about the likelihood of curing the disease in a child in other ways.
6. You need to know why a particular test or procedure is recommended and what the results can mean.
7. It is important to know what to expect if the child does not take the medicine or does not undergo the prescribed test or procedure.

If the doctor has scheduled the next meeting, you need to record the date, time and purpose of this visit. Additionally, it is recommended to find out how you can contact your doctor after hours. This is important if the child falls ill and you have questions or need quick advice.

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