Viral myocarditis in childhood

Viral myocarditis is an important condition that may be encountered by general paediatricians, general practitioners and paediatric cardiologists alike. Its presentation varies from asymptomatic and transient ECG changes to acute, fulminant heart failure and collapse. Clinicians must therefore have a high index of suspicion to enable its prompt recognition and the prevention of serious complications. A number of investigations are useful in assessing a child or adolescent with suspected viral myocarditis. Initial treatment is supportive, and a significant proportion of patients recover spontaneously. Although the use of immune-modulatory therapies is commonplace, there is little evidence to support this, and large, randomised, controlled clinical trials are needed to clarify this issue.