Overview
Enterovirus enteritis, particularly involving enterovirus 71, can lead to severe complications including rhombencephalitis and cardiac dysfunction without overt myocarditis, manifesting as left ventricular dysfunction and heart failure in pediatric patients 1.Diagnosis
Echocardiography: Essential for assessing left ventricular function, often revealing ejection fractions between 22-58% (mean 37%) 1.
Cardiac Biomarkers: Elevated muscle-brain fraction of creatine kinase >5% in some patients 1.
Hormonal Analysis: Significantly elevated plasma norepinephrine and epinephrine levels in selected cases 1.
Electrocardiography: Abnormalities noted in a subset of patients 1.
Clinical Signs: Tachycardia in all patients, systemic hypertension in some, and signs of pulmonary oedema in many 1.Management
Supportive Care: Focus on managing heart failure symptoms, including fluid management and monitoring pulmonary oedema 1.
Cardiac Monitoring: Continuous echocardiographic and electrocardiographic monitoring to guide treatment adjustments 1.
Symptom Control: Address tachycardia and hypertension with appropriate pharmacological interventions as indicated 1.Special Populations
Pediatrics: High prevalence and severity noted in young children, median age 14 months 1.Key Recommendations
Echocardiography for LV Function: Routinely perform echocardiography to assess left ventricular function in suspected cases of enterovirus rhombencephalitis (Evidence: Moderate) 1.
Monitor Cardiac Biomarkers: Evaluate muscle-brain fraction of creatine kinase and hormonal levels (norepinephrine, epinephrine) to guide clinical management (Evidence: Weak) 1.
Supportive Measures for Heart Failure: Implement supportive care measures targeting heart failure symptoms, including fluid management and pulmonary oedema prevention (Evidence: Expert opinion) 1.References
1 Fu YC, Chi CS, Chiu YT, Hsu SL, Hwang B, Jan SL et al.. Cardiac complications of enterovirus rhombencephalitis. Archives of disease in childhood 2004. link