Four faces of acute myopericarditis.

Abstract

Sixty patients with acute myocarditis or pericarditis or a combination of the two lesions, without endocarditis, were encountered by the authors in hospital and domiciliary consulting practice over a period of seven years. Similar cases have been reported under a variety of names; e.g. Coxsackie myopericarditis, acute nonspecific pericarditis, Bornholm disease, isolated myocarditis, Fiedler's myocarditis, and cardiomyopathy of pregnancy. The clinical presentation fell into 4 groups. I: I9 patients presented with classical symptoms of acute pericarditis. II: 24 presented as coronary mimics, with severe substernal pain unaffected, or only slightly affected, by respiration, posture, or movement. III: 3 presented with progressive heart failure. IV: I4 presented with miscellaneous symptoms, most frequently resembling influenza. Evidence of concurrent viral illness was found in IS patients, 9 being Coxsackie infections. Other specific diseases were identified in 3 patients; but in 42, including 3 who died and were examined at necropsy, the nature of the disease could not be established. Three patients died of heart failure, and in IO others the electrocardiogram remained abnormal over 3 months after the onset; the remaining patients made a complete recovery. Nine patients relapsed, 7 of them being in the group presenting with acute pericarditis. No specific treatment was found to be of value.

Serial Electrocardiographic Findings in Acute Myocarditis.

“…Interstitial edema and inflammatory myocardial lesion may also have been associated with this finding. Abnormal Q waves had been considered to be relatively rare findings (3). In previous reports ( 1-3), the frequency of abnormal Q waves ranges from 0 to 14%in myocarditis.…”

“…It is nowbelieved that most cases of acute myocarditis are induced by viral infection (1)(2)(3). Electrocardiographic findings of these cases often mimic AMI (4)(5)(6)(7).…”

Diagnosis and presentation of fatal myocarditis

“…The clinical diagnosis of myocarditis is made difficult by its variable and nonspecific presentations [2][3][4]. In addition to unexplained heart failure of recent onset, acute myocarditis commonly mimics myocardial infarction [5][6][7][8][9], or it may cause sudden unexpected death [10][11][12].…”

Incidence of three presentations of acute myocarditis in young men in military service. A 20-year experience

“…Acute myocarditis presents in many ways and distinct clinical forms of the disease have been established [7,8] . One presentation is acute or insidious heart failure without other obvious causes.…”