Mohamed Elgayar։ Not Every Elevated Troponin in a Child Is Myocarditis
Mohamed Elgayar, Pediatric Cardiac Critical Care Specialist at Magdi Yacoub Foundation, shared a post on LinkedIn:
”Not every elevated troponin in a child is myocarditis.
Troponin is a marker of myocardial injury – the differential in children is broad and includes Kawasaki disease, MIS-C, ALCAPA, sepsis-induced cardiomyopathy, arrhythmia-mediated ischemia, AKI, and rhabdomyolysis – before ever reaching a diagnosis of myocarditis.
When myocarditis is suspected, the diagnostic workup follows a systematic path:
- Serial troponin kinetics
- Hemodynamic assessment first
- Actively exclude competing diagnoses
- ECG and Echo (GLS is the most sensitive echo marker)
- Cardiac MRI with parametric mapping – Lake Louise Criteria 2018
- Endomyocardial biopsy in selected indications (fulminant, giant cell, eosinophilic)
Key reminder: normal ECG and normal echo do not exclude myocarditis.
And in fulminant disease – early MCS support carries a 60–70% recovery rate in children. Bridge to recovery, not just bridge to transplant.”
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