Symptomless myocarditis and myalgia in viral and Mycoplasma pneumoniae infections.

The cardiovascular manifestations of influenza: A systematic review

“…However, the association of persistent ECG changes with subsequent complications is unclear. Verel et al [26] and Lewes et al [25] do not report clinical heart disease in their patients with persistent ECG changes.…”

“…Lewes et al [25] report "ECG myocarditis" in 29% (2/7) of patients with mild influenza infection. One patient had ST and T wave inversion in leads I, aVL and V3−V6.…”

Endomyocardial Biopsy Findings in 50 Patients with Idiopathic Atrioventricular Block. Presence of myocarditis.

“…9) In contrast, there are few cases of subclinical myocarditis in which the sequelae are limited to conduction disturbances. Lewes, et al 15) described 6 patients with proven viral or Mycoplasma infection in whom myalgia along with significant ECG abnormalities were the only clinical findings ("symptomless myocarditis"). If we assume that myocarditis can be manifested by residual AV block or ECG abnormalities alone, the histologic findings of myocarditis in patients with presumed idiopathic AV block are not surprising.…”

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

“…Earlier clinical studies based the diagnosis of myocarditis on equivocal electrocardiographic changes in connection with infectious diseases but without other evidence of myocardial involvement [1,2] . This caused an obvious over-diagnosis of possible myocarditis, because as many as one third of patients hospitalized for Mycoplasma pneumoniae or viral infections displayed such nonspecific ECG changes [3] . More recent studies have used endomyocardial biopsy to diagnose myocarditis [4][5][6] .…”