ECG library
Myocarditis in a school-age child
advanced7 years old· school ageA 7-year-old, two weeks after a viral illness, with abdominal pain, vomiting and tiredness. He is pale, cool, and his liver edge is 3 cm below the ribs. The ECG was ordered because 'the heart rate would not come down'.
25 mm/s · 10 mm/mV · synthetic tracing
100%
Calipers:2000 ms50.0 small boxes30 bpm if R-RDrag the orange markers. One small box = 40 ms.
Key findings
- Sinus tachycardia out of proportion to the story
- Low voltage
- New T-wave inversion beyond V1 to V3
Learning points
- Myocarditis in children presents as gastroenteritis or pneumonia that will not behave: vomiting, abdominal pain, a tachycardia that persists after fluids, a liver you can feel.
- A tachycardia that does not settle with fever control and hydration needs an ECG; low voltage, ST or T changes and ectopy are the findings.
- The child with cool extremities, hepatomegaly and tachycardia is in cardiogenic shock until proven otherwise, and a fluid bolus can make it worse: senior help and an echocardiogram before the second bolus.
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