Uncommon, but often tricky to recognise, potentially lethal.

Multiple causes:

• Viral esp enterovirus
• Genetic
• Metabolic
• Autoimmune
• Chagas, Diphtheria important in other countries

Presents with anorexia, vomiting, breathlessness. Can be abdo pain (gut ischaemia?). Chest pain unusual, young children may struggle to describe anyway. Syncope or palpitations if arrhythmia. Confusion and agitation if acidotic.

Heart will eventually enlarge but may not be apparent initially. Inappropriate tachycardia; breathlessness with clear lungs and CXR (not always acidosis), esp with exertion. Hypotension.

May be new murmur eg MR if heart enlarged.

Small complexes, ST changes, q waves on ECG. Troponins may be high, LFTs deranged, renal impairment as secondary effects.

Echo diagnostic.

Start inotropes (peripheral possible). Various mechanical aids eg Berlin Heart, ECMO.