Table 1

Investigations in new onset paediatric failure (dilated left ventricle)

CMV, cytomegalovirus, EBV, Epstein-Barr virus; ESR, erythrocyte sedimentation rate; HIV, human immunodeficiency virus; PCR, polymerase chain reaction; RSV, respiratory syncytial virus; SLE, systemic lupus erythematosus.

  • Echocardiography (including check for anomalous coronary)

  • ECG

  • Myocarditis: Tracheal aspirate for viral PCR, paired serology (including coxsackie, adenovirus, echo, influenza, parainfluenza, varicella, RSV, rubella, CMV, EBV, HIV, parvovirus, mycoplasma, and endemic infections depending on geography—for example, Chagas' disease, dengue, diphtheria, Coxiella burnetti; many organisms cause myocarditis, and this list is not exclusive), troponin T, blood count for lymphocytosis. Myocardial biopsy (see text) for histology and PCR. Consider toxins if suggested by history, and illegal drugs (for example, cocaine)

  • Autoimmune: Anti-Ro and Anti-La, full SLE screen including antinuclear antibody, double stranded DNA, rheumatoid factor, ESR. Autoantibody screen (availability varies)—for example, anti-mysosin β receptor antibodies

  • Mitochondrial: Carnitine, acyl carnitine, lactate, glucose, white cell count for neutropenia, urine amino acids for methylglutaconic aciduria, muscle biopsy if clinical suspicion of mitochondrial disease. Molecular genetic diagnosis of Barth syndrome is available in some centres