Cardiac Complications in Children with Pneumonia and its Correlation with Severity of Pneumonia

Authors: Magda Y. H. El-Seify, Asmaa A. Ahmed, Omneya I. Youssef and Omnia A. Mahsoub

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Keywords: Pneumonia, Tachypnea, Dysnea, Auscultatory


Background: Pneumonia is a disease known by a mankind from antiquity. It is defined by the presence of one or several of the following recently acquired respiratory signs or symptoms as (poor feeding and irritability, tachypnea, retractions, grunting, hypoxemia, sputum production, dyspnoea, core body temperature more than 38.0 °C, auscultatory findings of abnormal breath, Cough may not be a feature initially since the alveoli have few cough receptors. Pneumonia is the single largest infectious cause of death in children worldwide. Pneumonia killed an estimated 922 000 children under the age of 5 in 2015, accounting for 15% of all deaths of children under five years old.

Aim of the Work: is to study cardiac complications in a group of Egyptian children with pneumonia and to correlate this with severity of pneumonia.

Patients and Methods: We included 50 patients that were recruited from the pediatric emergency room, inpatient wards, pediatric intensive care unit of the children’s hospital, Ain Shams university hospitals. In the current study, Patients’ age ranged from 40 days to 132 months old with median age 9 months. Group I (patients with moderate pneumonia): age ranged from 4 months to 60 months old with median age 10 months, Group II (patients with severe pneumonia): age ranged from 40 days to 132 months old with median age 9 months, Group III (control): age ranged from 4 to 132 months old with median age 17.5 months old. 2 patients (4%) died they were males with severe pneumonia admitted in the ICU, mechanically ventilated their echo showed pericardial effusion and left ventricular diltation with impaired ejection systolic functions <50 & prolonged QTc interval. All children enrolled in the study were subjected to the following in the first week of their presentation: thorough history taking, thorough clinical examination, Investigations: Chest x-ray, ECG, Echocardiography, 24 hour Holter monitoring, Laboratory investigation: Complete blood count, C-reactive protein, Serum electrolytes: Na, K, Ca, PO4, Tropinin T quantative test.

Results: As regards the sex distribution this study shows that 68% of patients males, 32% were females. Nearly all patients had Dysnea, cough, refusal of oral intake, fever, tachypnea, retractions and about 42% had diarrhea. These symptoms and signs were significantly higher in patients with severe pneumonia than in patients with moderate pneumonia. As for ECG findings in studied patients group 82% of patients had ECG abnormalities, 66% of patients had Holter abnormalities, 12% had echocardiographic abnormalities, Serum troponin T levels of studied patients group were all below reference value (0.01 ng /ml).

Conclusion: Pneumonia is a frequent and serious disease, it can be caused by many different organisms and it is an important cause of death. Acute pneumonia stresses the heart and can cause different cardiac complications as sinus tachycardia, prolonged and short QTc interval, depressed ST segment, myocarditis and pericarditis.