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. 1982 Apr;47(4):381–391. doi: 10.1136/hrt.47.4.381

Evaluation of mild acute infectious myocarditis.

J Heikkilä, J Karjalainen
PMCID: PMC481151  PMID: 6121567

Abstract

The diagnosis of acute mild myocarditis in vaguely defined. Therefore we studied 185 consecutive young men in military service with electrocardiographic changes arousing a suspicion of myocarditis in connection with an acute infectious disease. It was possible to classify 160 patients into seven electrocardiographic groups; definite or probable myocarditis was observed in 104 patients. The electrocardiographic patterns considered characteristic for acute myocarditis were: ST segment elevations followed by T wave inversions; gradually changing T wave inversions not corrected by beta blockade; and ventricular extrasystoles more than 10 per minute triggered by acute infection. Thirty-nine subjects without myocarditis had "functional" T wave abnormalities completely normalised by beta blockade, or stable T wave inversion. The leading symptoms in acute myocarditis were fatigue and chest pains; loud S3 gallop, paradoxical cardiac pulsation, pericardial friction rub, or enlargement of the heart were noted altogether in 50% of the patients. Echocardiography disclosed segmental wall motion abnormalities related to the T wave inversions. Serum creatine kinase MB fraction increased in 70% of the acute myopericarditis patients during the ST segment elevation stage. In the non-myocarditis groups the clinical and pertinent laboratory findings remained normal. Thus, we noted in clinically mild acute infectious myocarditis clear-cut and early signs of myocardial dysfunction, suggesting that the direct and often local viral invasion of the myocardium is the basic pathogenetic mechanism. The present electrocardiographic classification based on serial tracings and beta blockade proved useful in the evaluation of patients suspected of having mild acute myocarditis.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Abelmann W. H. Virus and the heart. Circulation. 1971 Nov;44(5):950–956. doi: 10.1161/01.cir.44.5.950. [DOI] [PubMed] [Google Scholar]
  2. Atterhög J. H. A 5-year follow-up of young men with primary T wave aberrations in their electrocardiograms. Acta Med Scand. 1981;209(1-2):75–82. doi: 10.1111/j.0954-6820.1981.tb11555.x. [DOI] [PubMed] [Google Scholar]
  3. Bengtsson E., Lamberger B. Five-year follow-up study of cases suggestive of acute myocarditis. Am Heart J. 1966 Dec;72(6):751–763. doi: 10.1016/0002-8703(66)90158-x. [DOI] [PubMed] [Google Scholar]
  4. Burch G. E., Giles T. D. The role of viruses in the production of heart disease. Am J Cardiol. 1972 Feb;29(2):231–240. doi: 10.1016/0002-9149(72)90634-0. [DOI] [PubMed] [Google Scholar]
  5. DesA'neto A., Bullington J. D., Bullington R. H., Desser K. B., Benchimol A. Coxsackie B5 heart disease. Demonstration of inferolateral wall myocardial necrosis. Am J Med. 1980 Feb;68(2):295–298. doi: 10.1016/0002-9343(80)90370-8. [DOI] [PubMed] [Google Scholar]
  6. Furberg C. Adrenergic beta-blockade and electrocardiographical ST-T changes. Acta Med Scand. 1967 Jan;181(1):21–32. doi: 10.1111/j.0954-6820.1967.tb07221.x. [DOI] [PubMed] [Google Scholar]
  7. Gardiner A. J., Short D. Four faces of acute myopericarditis. Br Heart J. 1973 Apr;35(4):433–442. doi: 10.1136/hrt.35.4.433. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Gatmaitan B. G., Chason J. L., Lerner A. M. Augmentation of the virulence of murine coxsackie-virus B-3 myocardiopathy by exercise. J Exp Med. 1970 Jun 1;131(6):1121–1136. doi: 10.1084/jem.131.6.1121. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Gerzen P., Granath A., Holmgren B., Zetterquist S. Acute myocarditis. A follow-up study. Br Heart J. 1972 Jun;34(6):575–583. doi: 10.1136/hrt.34.6.575. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. KILBOURNE E. D., WILSON C. B., PERRIER D. The induction of gross myocardial lesions by a Coxsackie (pleurodynia) virus and cortisone. J Clin Invest. 1956 Apr;35(4):362–370. doi: 10.1172/JCI103286. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Karjalainen J., Nieminen M. S., Heikkilä J. Influenza A1 myocarditis in conscripts. Acta Med Scand. 1980;207(1-2):27–30. doi: 10.1111/j.0954-6820.1980.tb09670.x. [DOI] [PubMed] [Google Scholar]
  12. Koskenvuo K. Sudden deaths among Finnish conscripts. Br Med J. 1976 Dec 11;2(6049):1413–1415. doi: 10.1136/bmj.2.6049.1413. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Levine H. D. Virus myocarditis: a critique of the literature from clinical, electrocardiographic, and pathologic standpoints. Am J Med Sci. 1979 Mar-Apr;277(2):132–143. [PubMed] [Google Scholar]
  14. Lewes D., Rainford D. J., Lane W. F. Symptomless myocarditis and myalgia in viral and Mycoplasma pneumoniae infections. Br Heart J. 1974 Sep;36(9):924–932. doi: 10.1136/hrt.36.9.924. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Mason J. W., Billingham M. E., Ricci D. R. Treatment of acute inflammatory myocarditis assisted by endomyocardial biopsy. Am J Cardiol. 1980 May;45(5):1037–1044. doi: 10.1016/0002-9149(80)90174-5. [DOI] [PubMed] [Google Scholar]
  16. Somer H., Konttinen A. A method allowing the quantitation of serum creatine kinase isoenzymes. Clin Chim Acta. 1972 Feb;36(2):531–536. doi: 10.1016/0009-8981(72)90030-7. [DOI] [PubMed] [Google Scholar]
  17. Spodick D. H. Electrocardiogram in acute pericarditis. Distributions of morphologic and axial changes by stages. Am J Cardiol. 1974 Apr;33(4):470–474. doi: 10.1016/0002-9149(74)90603-1. [DOI] [PubMed] [Google Scholar]
  18. Taggart P., Carruthers M., Joseph S., Kelly H. B., Marcomichelakis J., Noble D., O'Neill G., Somerville W. Electrocardiographic changes resembling myocardial ischaemia in asymptomatic men with normal coronary arteriograms. Br Heart J. 1979 Feb;41(2):214–225. doi: 10.1136/hrt.41.2.214. [DOI] [PMC free article] [PubMed] [Google Scholar]

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