A 7-year-old boy presents with acute onset breathlessness, chest pain, and hypotension. He had a flu-like illness 2 weeks ago. Examination reveals tachycardia at 150/min, gallop rhythm, hepatomegaly, and cold peripheries. Chest X-ray shows cardiomegaly with pulmonary congestion. ECG shows low voltage QRS complexes. What is the most likely diagnosis?

• A Septic shock
• B Acute viral myocarditis ✓
• C Dilated cardiomyopathy
• D Pericardial tamponade

Explanation

Acute myocarditis presents with a preceding viral illness followed by acute heart failure signs: gallop rhythm, cardiomegaly, pulmonary congestion, and low voltage on ECG. The presentation mimics septic shock but the cardiomegaly, gallop rhythm, and recent viral prodrome point to myocarditis. Pericardial tamponade would have muffled heart sounds and clear lungs. Dilated cardiomyopathy is usually subacute or chronic.

Reference: Nelson Textbook of Pediatrics, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.