Inflammatory diseases of the heart

The inflammatory diseases of the heart contribute signifi cantly to the morbidity and mortality of our pediatric patients. This chapter focuses on the disease processes of infective endocarditis, Kawasaki disease and myocarditis as well as their respective management. Endocarditis is a rare diagnosis in pediatrics and those with congenital heart disease particularly with prosthetic material and residual lesions resulting in turbulent blood flow are at particular risk. Management is long-term courses with combination antimicrobials. Complications are not rare and surgical intervention is often employed. Kawasaki disease is prevalent in the pediatric population and while self-limited in nature, can result in lifethreatening coronary aneurysms and stenoses. A high-index of suspicion is often necessary to diagnose these children. Intravenous immunoglobulin and aspirin are the mainstays of therapy. Long-term, these patients need to be monitored closely for coronary complications. Myocarditis causes cardiac dysfunction and can result in a cardiogenic shock and circulatory collapse. It can also progress to a dilated cardiomyopathy. Myocarditis is caused most commonly by viruses but also other infectious agents, drugs and systemic illness can be the culprit. Treatment is largely supportive with use of inotropic agents and other heart failure medications. Mechanical circulatory support is often employed. Some of these patients will ultimately require cardiac transplantation.