Turkiye Klinikleri Journal of Pediatrics

.: ORIGINAL RESEARCH
Miyoperikardit/Perimiyokardit Hastaların Retrospektif Değerlendirilmesi: Retrospektif Araştırma
Retrospective Evaluation of Myopericarditis/Perimyocarditis Patients: Retrospective Research
Fatoş ALKANa, Şenol COŞKUNa
aCelal Bayar Üniversitesi Tıp Fakültesi, Çocuk Kardiyoloji BD, Manisa, TÜRKİYE
Turkiye Klinikleri J Pediatr. 2021;30(3):199-204
doi: 10.5336/pediatr.2021-82280
Article Language: TR
Full Text
ÖZET
 Amaç: Perimiyokardit miyokardın, miyoperikardit ise perikardın daha baskın olarak etkilendiği ancak hem miyokardın hem de perikardın da kısmen tutulumu ile karakterize inflamatuar sendromlardır. Bu çalışmada, kliniğimizde akut perimiyokardit ve miyoperikardit tanısı alan hastaların başvuru klinik prezentasyonu, laboratuvar ayırıcı tanı, görüntüleme teknikleri ve klinik deneyimlerimizle beraber tedavi yönetimimizin mortaliteye etkisinin değerlendirilmesi amaçlanmıştır. Gereç ve Yöntemler: Çocuk kardiyoloji birimine 01.01.2015- 01.08.2017 tarihleri arasında başvuran perimiyokardit/miyoperikardit tanısı almış hastaların dosyaları retrospektif olarak incelendi. Hastaların demografik özellikleri, laboratuvar ve ileri görüntüleme sonuçları kaydedildi. Bulgular: Hastaların yaş aralığı 1-17 yıl (13±5,47) idi. Başvuru yakınması 16 (%88,9) hastada göğüs ağrısı, bir hastada ateş, bir hastada enterit idi. Kardiyak enzimler tüm hastalarda yüksek bulundu. Beş hastanın (%27,7) ejeksiyon fraksiyonu (EF) %55'in altında izlendi. Mortalite bir hastada izlendi. İntravenöz immünglobulin (IVIG) alan ve almayan hastalarla sol ventrikül diyastolik ve sistolik çapları, EF, fraksiyonel kısalma, göğüs ağrısı arasında fark saptanmadı (p=0,566, 1,000, 0,095, 0,208). Sonuç: Göğüs ağrısı, çarpıntı gibi şikâyetlerle başvuran ve öyküsünde üst solunum yolu enfeksiyonu olan hastalarda ön planda perimiyokardit/miyoperikardit akla gelmelidir. Sıklıkla tedavisiz de kendini sınırlayan bir hastalık olmasına rağmen bu hastaların yatarak yakın izlemi seçili hastalarda nonsteroidal antiinflamatuar ilaçlar ile beraber IVIG uygulanması da göz önünde bulundurulmalıdır.

Anahtar Kelimeler: Miyokardit; göğüs ağrısı; perikardit
ABSTRACT
 Objective: Myocardium is predominantly affected in perimyocarditis and pericardium in myopericarditis; yet, both are inflammatory syndromes characterized by partial involvement of both myocardium and pericardium. This study aimed to evaluate the clinical presentation at the time of referral, laboratory differential diagnoses, imaging techniques, and our clinical experience in patients diagnosed with acute perimyocarditis/myopericarditis in our clinic, along with the effect of our treatment management on mortality. Material and Methods: The files of the patients diagnosed with perimyocarditis/myopericarditis referred to the pediatric cardiology unit between 01.01.2015- 01.08.2017 were retrospectively analyzed. The patients' demographic characteristics, physical examination findings and advanced imaging examination results were recorded. Results: The age range of the patients was 1-17 years (13±5.47). The referral complaints were chest pain in 16 (88.9%) patients, fever in one patient, and enteritis in one patient. Cardiac enzyme levels were high in all patients. The ejection fraction (EF) of five patients (27.7%) was below 55%. Mortality was observed in only one patient. There was no difference between patients who received intravenous immunoglobulin (IVIG) and those who did not, in terms of left ventricular diastolic and systolic diameters, EF, fractional shortening, and chest pain (p=0.566, 1.000, 0.095, 0.208, respectively). Conclusion: Perimyocarditis/myopericarditis should be considered in patients who present with complaints such as chest pain and palpitations and who have a history of upper respiratory tract infection. Although perimyocarditis/myopericarditis is often a self-limiting disease even without treatment, close follow-up of these patients with hospitalization should be taken into consideration, and IVIG administration together with non-steroidal anti-inflammatory drugs should be considered in selected patients.

Keywords: Myocarditis; chest pain; pericarditis
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