CLINICAL AND INSTRUMENTAL CRITERIA FOR EARLY DIAGNOSIS OF CARDITIS IN PEDIATRICS: AN INTEGRATED, STEPWISE FRAMEWORK

To develop an integrated, stepwise framework for early recognition of pediatric carditis—including myocarditis, rheumatic carditis, and cardiac involvement in MIS-C/Kawasaki phenotypes—by combining clinical “red flags,” laboratory markers, electrocardiography (ECG), echocardiography (echo), and cardiac magnetic resonance (CMR) into practical decision pathways for different care settings. Early diagnosis of pediatric carditis remains challenging due to heterogeneous etiologies, age-dependent presentations, and variability in test availability across primary, secondary, and tertiary care. Delayed verification risks progression to heart failure, adverse remodeling, and chronic valvular pathology. Narrative synthesis of contemporary pediatric and cardiology guidance (SERVQUAL omitted; focus on medicine), emphasizing the 2018 updated Lake Louise CMR criteria for myocarditis, echocardiographic standards from the World Heart Federation (WHF) for rheumatic heart disease (2012; 2023 update), the revised Jones criteria (2015), and MIS-C frameworks (post-COVID era). The article translates these into implementable checklists, tables, and a stepwise diagnostic route with escalation triggers. We propose a triad-based workflow—Clinical profile → Core triage tests (troponin/NT-proBNP, ECG, echocardiography) → Etiologic confirmation (CMR for myocarditis; echo-based WHF/Jones pathways for rheumatic disease; MIS-C criteria with cardiac focus)—supported by standardized thresholds, minimum datasets, and quality checkpoints. Tables summarize age-specific red flags, biomarker thresholds and interpretation, ECG and echo findings by etiology, CMR markers per Lake Louise, and differential diagnoses. A structured, context-aware diagnostic route reduces missed early presentations and accelerates therapy initiation while aligning with ethical/operational constraints (radiation minimization, sedation avoidance, and informed consent). The framework is adaptable to resource-variable settings and supports consistent documentation for longitudinal follow-up.