1. Pediatric Chest Pain - Myocarditis
2. Neuroleptic Malignant Syndrome
- Difficult diagnosis to make and often missed, occasionally with fatal consequences. Remain vigilant!
- ECG is most sensitive study, though still only 90% Sinus tachycardia may be only sign.
- Viral etiology most common, though can be bacterial, autoimmune or toxic.
- Treatment is supportive, with pediatric cardiology involvement early.
- Lyme carditis presents most commonly as complete heart block, complicating 1% of Lyme disease cases.
- Other rare causes of carditis include Rickettsial disease, Chagas disease, Dengue fever, West Nile virus and Chikungunya.
2. Neuroleptic Malignant Syndrome
- Multiple diagnostic criteria, but all have hyperthermia and muscle rigidity as core components. Other elements are altered mental status/agitation, autonomic instability, dyspnea, dysphagia and incontinence.
- Typical antipsychotics are the most frequent culprit, but can be seen with all antipsychotics as well several other medications. Also seen following withdrawal of Parkinsonian medications (L-dopa).
- Supportive care is paramount! Fluid resuscitate, cool patient and consider intubation/paralysis to prevent complications associated with severe muscle rigidity (rhabdomyolysis). Dantrolene/bromocriptine/amantadine discussed in literature, but secondary to symptomatic support.