rss
Arch Dis Child 2004;89:368-373 doi:10.1136/adc.2003.029645
  • Acute paediatrics

Cardiac complications of enterovirus rhombencephalitis

  1. Y C Fu1,
  2. C S Chi1,
  3. Y T Chiu2,
  4. S L Hsu2,
  5. B Hwang4,
  6. S L Jan1,
  7. P Y Chen1,
  8. F L Huang1,
  9. Y Chang3
  1. 1Departments of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan
  2. 2Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
  3. 3Section of Cardiovascular Surgery, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
  4. 4Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
  1. Correspondence to:
    Dr C S Chi
    Department of Pediatrics, Taichung Veterans General Hospital, 160, Section 3, Chung-Kang Road, Taichung 40705, Taiwan, Republic of China; chi0316vghtc.vghtc.gov.tw
  • Accepted 3 August 2003

Abstract

Background: Epidemics of enterovirus 71 infection have caused the death of many children throughout the world. Rhombencephalitis, brain stem encephalitis, and heart failure were present in all of the fatal cases. However, no evidence of myocarditis was noted in the heart specimens, and the mechanism of heart failure remains unknown.

Aims: To characterise the presentation of cardiac complications in children with enterovirus rhombencephalitis and discuss its pathogenesis.

Methods: Ninety one consecutive patients with enterovirus rhombencephalitis underwent echocardiography. Of these, 17 patients (nine male, eight female; median age 14 months, range 4–57 months) with left ventricular dysfunction were studied.

Results: Tachycardia was noted in all patients and systemic hypertension in 12. Muscle-brain fraction of creatine kinase was >5% in 14 patients. Plasma norepinephrine and epinephrine levels were significantly raised in the three patients in whom these were analysed. Electrocardiographic abnormalities were noted in eight patients. Pulmonary oedema was complicated in 15 patients. The initial ejection fraction of the left ventricle was 22–58% (mean 37%, SD 11%). All patients deteriorated to hypotensive shock within 12 hours and 13 died. Heart specimens from seven patients showed no evidence of myocarditis, but significant coagulative myocytolysis, myofibrillar degeneration, and cardiomyocyte apoptosis were observed.

Conclusions: Acute heart failure was noted in 19% of patients with enterovirus rhombencephalitis, which had a fatality rate of 77%. It was not caused by myocarditis but possibly by neurogenic cardiac damage.

Footnotes

    This Article

    1. Abstract
    2. Full text
    3. PDF

    Responses

    1. Submit a response
    2. No responses published

    Register for free content


    Free trial
    Individuals may register for a free 30 day online trial to all content.

    Free archive
    The full back archive is now available for all BMJ Journals. Institutional subscribers may access the entire archive as part of their subscription. Personal subscribers will also have access to all content when logged in. Non-subscribers who register have free access to all articles published before 2006 right back to volume 1 issue 1. Register here to access the free archive of all BMJ Journals.

    Don't forget to sign up for content alerts so you keep up to date with all the articles as they are published.