Myocarditis

Abstract

A review of selected papers on myocarditis published during the past decade and an analysis of some original data together with personal experiences have been presented. All of these indicate that the clinical diagnosis of myocarditis is made far too infrequently as contrasted with the high incidence of this disease as recognized by pathologists. It is estimated that approximately 10 per cent of all patients coming to necropsy will demonstrate some evidence of myocarditis. The discrepancy between the clinical and the pathologic incidences can possibly be ascribed to two factors, namely, (a) the relatively innocent nature of the clinical and laboratory findings in many cases, and (b) the apparent reluctance of the clinician to make the diagnosis. It is likely that a correct diagnosis of myocarditis will be made more often and cardiac catastrophies avoided if the clinician will consider the possibility of the diagnosis, particularly in the course of all types of infectious diseases.

False "Coronary Patterns" in the Infant Electrocardiogram

“…17 However, S-T deviations in particular are not a constant feature in this condition. [18][19][20][21][22][23] In our cases the analogy with a pattern of acute infaret was particularly striking in view of the deep Q waves in the left precordial leads in one, and in leads III and aVF in the other. Since no confluent area of tissue necrosis was found anatomically, a severe functional alteration of a large portion of the myocardium must have been present, resulting in the failure of the latter to contribute electromotive forces to the initial stages of ventricular activation.…”

“…3, [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] showed as the outstanding abnormality all ST-T deviation of discordant type. Ill leads I, aVr, and V4 to Vr,, the kS-T was mitarkedly\ elevated in contrast to equally prominent S-T depression in Il, III, aVF, and V1~to V,.…”

“…A left aortic arch was seen to originate from the left ventricle, and a tiny pulmonary artery appeared to communicate with the right ventricle. The [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] showed an unchanged sinus rate and P-R interval. The precordial leads revealed prominent R waves with an upright T wave in the right precordial leads and predominant S waves in the left, suggesting right ventricular hypertrophy.…”

“…A common coronary ostium in the aorta, present in case 4, does not interfere with normal blood supply to the myocardium. 23 We are aware that electrocardiographic changes of the type illustrated in figures 4 and 5 are at variance with the usual effects of digitalis in adults26-29 as well as in children and infants. [30][31][32] Ordinarily the S-T deviations develop in a direction opposite to, rather than parallel to, the main QRS de-flection, in keeping with experimentally produced lesions in the subendocardium.…”

Studies in Myocarditis

“…Experience in litis investigation stresses that the diagnosis of myocarditis must not be neglected in a department of internal me dicine (14,21,53,54). The clinical importance, the course and prognosis of a myocarditis varies, however, greatly.…”