Cardiomyopathy
Echocardiography in acute infectious myocarditis: Relation to clinical and electrocardiographic findings

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Abstract

Multidirectional M-mode echocardiography (echo) was used to investigate functional and structural changes of the heart in 68 consecutive patients with acute or subacute infectious myocarditis. Forty patients had mild myocardial involvement evident by gradually changing ST-segment or T-wave alterations (not responsive to β blockade) in serial ECGs; 21 patients also had loud S3 gallop and palpable paradoxical cardiac pulsations, and 7 patients had severe congestive heart failure.

Echo revealed regional changes in the left ventricular (LV) contraction in all patients with acute myocarditis. The site and size of the asynergic wall motion abnormalities correlated with both the clinical severity of the disease and the location of the T-wave inversions in the ECG. In mild myocarditis hypokinesia only was noted in 1 to 3 sites (mean 2.3) of 11 recorded LV sites (21%). In moderate myocarditis, the local asynergic change was mainly akinesia and more widespread, being surrounded by hypokinetic regions (3.8 of 11 sites, 35 % of the LV sites). In congestive heart failure, the hypokinetic or akinetic segments affected almost the entire left ventricle (7.6 of 11 sites, 69% of the LV sites) (p < 0.001 between the groups). In the last group, all patients had strong “fibrotic” echoes, in contrast to mild myocarditis (13%). In mild infectious myocarditis the contraction disturbance of the asynergic regions also generated a peculiar “quivering” pattern with thin echo lines. In the uninvolved segments, hyperkinesia was observed in most patients. The LV end-diastolic diameters in the 3 groups were 51 ± 5, 58 ± 4 and 65 ± 5 mm (p < 0.05), respectively. Thus, M-mode echo may provide a sensitive technique for detecting LV involvement in acute myocarditis and following its course.

References (24)

  • J Karjalainen

    Functional and myocarditis-induced T-wave abnormalities. Effect of orthostasis, β-blockade, and epinephrine

    Chest

    (1983)
  • AM Hauser et al.

    Severe transient left ventricular “hypertrophy” occurring during acute myocarditis

    Chest

    (1983)
  • J Heikkilä et al.

    Evaluation of mild acute infectious myocarditis

    Br Heart J

    (1982)
  • J Karjalainen et al.

    Etiology of mild acute infectious myocarditis. Relation of clinical features

    Acta Med Scand

    (1983)
  • G Friman

    Effects of acute infectious disease on circulatory function

    Acta Med Scand

    (1976)
  • MS Nieminen et al.

    Usefulness of multiaxis echocardiography in assessment of the left ventricle in ischemic heart disease. A review

    Acta Med Scand

    (1982)
  • J Roelandt et al.

    Recommendations for standardization of measurements from M-mode echocardiograms

    Eur Heart J

    (1980)
  • K Lindvall et al.

    Echo- and electrocardiographic findings in relation to autopsy in myocardial infarction

    Clin Cardiol

    (1982)
  • MS Nieminen

    Normal left echoventriculography

    Ann Clin Res

    (1975)
  • S Rasmussen et al.

    Detection of myocardial scar tissue by M-mode echocardiography

    Circulation

    (1978)
  • J Heikkilä et al.

    Echoventriculography in acute myocardial infarction. IV. Infarct size and reliability by pathologic anatomic correlations

    Clin Cardiol

    (1980)
  • K Koskenvuo

    Sudden deaths among Finnish conscripts

    Br Med J

    (1976)
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