Table 4.

Cardiac management of MIS-C^*

Guidance statement	Level of consensus
Patients with MIS-C and abnormal BNP and/or troponin T levels at diagnosis should have these laboratory parameters trended over time until they normalize.	High
EKGs should be performed at a minimum of every 48 hours in MIS-C patients who are hospitalized and during follow-up visits. If conduction abnormalities are present, patients should be placed on continuous telemetry while in the hospital, and Holter monitors should be considered during follow-up.	Moderate to high
Echocardiograms conducted at diagnosis and during clinical follow-up should include evaluation of ventricular/valvular function, pericardial effusion, and coronary artery dimensions with measurements indexed to body surface area using z-scores.	High
Echocardiograms should be repeated at a minimum of 7–14 days and 4–6 weeks after presentation. For those patients with cardiac abnormalities occurring in the acute phase of their illness, an echocardiogram 1 year after MIS-C diagnosis could be considered. Patients with LV dysfunction and/or CAAs will require more frequent echocardiograms.	Moderate to high
Cardiac MRI may be indicated 2–6 months after MIS-C diagnosis in patients who presented with significant transient LV dysfunction in the acute phase of illness (LV ejection fraction <50%) or persistent LV dysfunction. Cardiac MRI should focus on myocardial characterization, including functional assessment, T1/T2-weighted imaging, T1 mapping and extracellular volume quantification, and late gadolinium enhancement.	High
Cardiac CT should be performed in patients with suspected presence of distal CAAs that are not well seen on echocardiogram.	Moderate

^*MIS-C = multisystem inflammatory syndrome in children; BNP = B-type natriuretic peptide; EKGs = electrocardiograms; LV = left ventricular; CAAs = coronary artery aneurysms; MRI = magnetic resonance imaging; CT = computed tomography.