Mesalamine-Induced Myocarditis and Coronary Vasculitis in a Pediatric Ulcerative Colitis Patient: A Case Report

Mesalamine-containing products are often a first-line treatment for ulcerative colitis. Severe adverse reactions to these products, including cardiovascular toxicity, are rarely seen in pediatric patients. We present a case of a 16-year-old boy with ulcerative colitis treated with Asacol, a mesalamine-containing product, who developed sudden onset chest pain after four weeks on therapy. Serial electrocardiograms showed nonspecific ST segment changes, an echocardiogram showed mildly decreased left ventricular systolic function with mild to moderate left ventricular dilation and coronary ectasia, and his troponins were elevated. Following Asacol discontinuation, his chest pain resolved, troponins were trending towards normal, left ventricular systolic function normalized, and coronary ectasia improved within 24 hours suggesting an Asacol-associated severe drug reaction. Mesalamine-induced cardiovascular toxicity, although rare, may represent a life-threatening disorder. Therefore, every patient presenting with acute chest pain should receive a workup to rule out this rare drug-induced disorder

Mesalamine-Induced Myocarditis and Coronary Vasculitis in a Pediatric Ulcerative Colitis Patient: A Case Report

Mesalamine-containing products are often a first-line treatment for ulcerative colitis. Severe adverse reactions to these products, including cardiovascular toxicity, are rarely seen in pediatric patients. We present a case of a 16-year-old boy with ulcerative colitis treated with Asacol, a mesalamine-containing product, who developed sudden onset chest pain after four weeks on therapy. Serial electrocardiograms showed nonspecific ST segment changes, an echocardiogram showed mildly decreased left ventricular systolic function with mild to moderate left ventricular dilation and coronary ectasia, and his troponins were elevated. Following Asacol discontinuation, his chest pain resolved, troponins were trending towards normal, left ventricular systolic function normalized, and coronary ectasia improved within 24 hours suggesting an Asacol-associated severe drug reaction. Mesalamine-induced cardiovascular toxicity, although rare, may represent a life-threatening disorder. Therefore, every patient presenting with acute chest pain should receive a workup to rule out this rare drug-induced disorder

Mesalamine-Induced Myocarditis and Coronary Vasculitis in a Pediatric Ulcerative Colitis Patient: A Case Report

Mesalamine-containing products are often a first-line treatment for ulcerative colitis. Severe adverse reactions to these products, including cardiovascular toxicity, are rarely seen in pediatric patients. We present a case of a 16-year-old boy with ulcerative colitis treated with Asacol, a mesalamine-containing product, who developed sudden onset chest pain after four weeks on therapy. Serial electrocardiograms showed nonspecific ST segment changes, an echocardiogram showed mildly decreased left ventricular systolic function with mild to moderate left ventricular dilation and coronary ectasia, and his troponins were elevated. Following Asacol discontinuation, his chest pain resolved, troponins were trending towards normal, left ventricular systolic function normalized, and coronary ectasia improved within 24 hours suggesting an Asacol-associated severe drug reaction. Mesalamine-induced cardiovascular toxicity, although rare, may represent a life-threatening disorder. Therefore, every patient presenting with acute chest pain should receive a workup to rule out this rare drug-induced disorder

Pediatric Electrocardiograms For The General Practitioner: The Importance Of The T-Wave

Electrocardiograms may be used to screen for cardiovascular disease (CVD) in children. Many forms of CVD that predispose to sudden cardiac death are associated with T-wave abnormalities in childhood. The T-wave is generated during ventricular repolarization. T-waves on an electrocardiogram typically undergo maturational changes throughout childhood and adolescence. A pediatric practitioner’s ability to understand these changes is required to understand abnormal T-waves and recognize potentially life-threatening types of CVD. This review article uses a series of illustrative cases to highlight CVD associated with T-wave abnormalities in childhood

Cardiomyocyte injury to transplant: pediatric management

Cardiomyocyte injury in pediatric patients has a vast number of causes, which are often distinct from the causes of adult heart failure. However, the management of pediatric heart failure and heart transplantation has generally been inferred from adult studies. New therapies show great promise for the neurohormonal regulation of heart failure and the ability to control immunosuppression after heart transplantation. Large, randomized, multicenter, controlled clinical trials are needed to determine the efficacy of these therapies in this population. This article reviews the current recommendations and evidence-based medicine, where available, for the medical management of myopathic dysfunction and transplantation in pediatric patients

Diagnosis and screening of hypertrophic cardiomyopathy in children

Hypertrophic cardiomyopathy is the most common inherited cardiovascular disorder and the leading cause of sudden cardiac death in young people in the United States. Wide genetic heterogeneity and phenotypic expression are seen in hypertrophic cardiomyopathy and can make this disorder difficult to recognize in the general public. Population based screening for hypertrophic cardiomyopathy is aimed to allow for early detection, earlier treatment, promote complete family screening and to hopefully prevent some cases of sudden cardiac death in the community. A screening regimen consisting of a directed medical history and physical exam is currently recommended in the United States. The addition of electrocardiography is routine in some countries and can help guide the utilization of more expensive or invasive testing. Tools such as echocardiography, magnetic resonance imaging, serum biomarkers, and genetic testing are then directed to specific individuals to maximize their diagnostic and prognostic impact. Currently, no specific or widespread screening program has been uniformly adopted across the United States, as costs, benefits and the hazards of false positive diagnoses have yet to be balanced and decided. A working knowledge and appropriate suspicion for HCM remains fundamental for clinicians in order to diagnosis this important disorder

Coronary artery calcifications in the long-term follow-up of Kawasaki disease

To determine if detection of coronary artery calcifications in patients with Kawasaki disease may serve as a noninvasive predictor of future coronary artery events. A prospective, cohort pilot study that included 18 patients with Kawasaki disease >1 year from the acute disease was performed including 9 patients with coronary abnormalities during the acute illness (Group 1) and 9 without coronary abnormalities (Group 2). Patients were classified by echocardiography as having none, resolved, or residual coronary artery abnormalities. Electron beam computed tomography (EBCT) scans were completed using the Agatson coronary calcium scoring system. Intermediate follow-up was performed 2.5 years after EBCT to determine if clinically significant coronary artery events (myocardial infarction or sudden death) had occurred. Late echocardiographic abnormalities corresponded with the early echocardiographic abnormalities in 5 of 9 patients ( P = .029) in Group 1. The late echocardiographic abnormalities significantly correlated with detection of calcifications by EBCT in 4 of 5 patients (95% CI 28%-99%). One patient with residual coronary abnormalities and coronary artery calcifications with the highest calcium score subsequently had a sudden death. Detection of coronary artery calcifications may be predictive of sudden death ( P = .056). No residual echocardiographic abnormalities, coronary artery calcifications, or coronary artery events occurred in Group 2 patients. Patients with Kawasaki disease with residual coronary abnormalities show EBCT evidence of coronary artery calcifications. Detection of coronary artery calcifications may be useful for risk stratification in the long-term management of patients with Kawasaki disease