Acute fulminant myocarditis at autopsy: A clinical masquerade?

• Main Authors: S.Y. Patil (Author), P.R. Malur (Author), H.S. Gouda (Author), Lavlesh Kumar (Author), H.B. Bannur (Author), R.S. Davanageri (Author)
• Format: Book
• Published: Al Ameen Medical College, 2012-10-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.
• Notes: 0974-1143
• Keywords: Myocarditis; Myocardial infarction; Autopsy.; Therapeutics. Pharmacology; RM1-950; Toxicology. Poisons; RA1190-1270
• Source: Al Ameen Journal of Medical Sciences, Vol 05, Iss 04, Pp 410-413 (2012)

Background: Myocarditis is a diagnostic challenge in cardiology. The diagnosis is frequently made post-mortem, with no clinical evidence of myocardial failure. Autopsy studies report a frequency of myocarditis ranging from 0.11-0.55% in the general population. Myocarditis is presents with varied clinical manifestations, ranging from asymptomatic to sudden cardiac death, sometimes mimicking the Myocardial Infarction (MI). Case Summary: A 55 years old male presented with sudden onset of chest pain, breathlessness at rest and flu like symptoms 5-6 days prior to admission. There was tachycardia with low Systolic blood pressure and muffled heart sounds. ECG showed ST segment & T wave changes. CK-MB was moderately raised. Though clinically diagnosed as MI and treated, patient expired the next day. On autopsy, gross examination of heart revealed no significant findings. Histological examination revealed fulminant myocarditis involving right ventricle, interventricular septum, left ventricular wall and A-V Node. Conclusion: It is not uncommon to find Myocarditis patients presenting with manifestations of MI and these cases often misdiagnosed as MI. In such cases, myocarditis should be considered as a differential diagnosis. Endomyocardial biopsies and histological examination of the myocardium is absolutely necessary for reliable diagnosis of the disease.