title: Clinical course of myocarditis through the acute, fulminant and fatal chronic stages: an autopsy case.
abstract: Most patients with acute myocarditis manifest particular clinical signs and symptoms, including marked cardiac failure and/or a high degree of atrioventricular block on admission. However, a 78-year-old man did not have symptoms and was hospitalized as a result of abnormalities observed on an incidentally obtained electrocardiogram (ECG). Several days later, he developed cardiogenic shock and fulminant myocarditis, which required percutaneous cardiopulmonary support; however, the cardiac failure persisted and he died approximately 4 months later. The ECG showed findings similar to those of acute inferior myocardial infarction, and on left ventriculography, diffuse hypokinesis was observed most prominently in the inferoposterior wall. During autopsy, interstitial fibrosis was marked in the inferoposterior wall, with small, round, cell infiltration prominent at the same site. Clustering of these cells is a characteristic feature of chronic myocarditis.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Fujita Health University School of Medicine, Toyoake, Japan. hirazy@fujita-hu.ac.jp
authors.forename: Shinya
authors.initials: S
authors.lastname: Hiramitsu
authors.forename: Shin-ichiro
authors.initials: S
authors.lastname: Morimoto
authors.forename: Shigeru
authors.initials: S
authors.lastname: Kato
authors.forename: Akihisa
authors.initials: A
authors.lastname: Uemura
authors.forename: Masatsugu
authors.initials: M
authors.lastname: Ohtsuki
authors.forename: Yasuchika
authors.initials: Y
authors.lastname: Kato
authors.forename: Kenji
authors.initials: K
authors.lastname: Miyagishima
authors.forename: Nami
authors.initials: N
authors.lastname: Mori
authors.forename: Ryuji
authors.initials: R
authors.lastname: Yoda
authors.forename: Kazumasa
authors.initials: K
authors.lastname: Mori
authors.forename: Hisashi
authors.initials: H
authors.lastname: Kimura
authors.forename: Naoki
authors.initials: N
authors.lastname: Yamamoto
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Hishida
mesh_terms: D000368:Aged; D001344:Autopsy; D002908:Chronic Disease; D018450:Disease Progression; D004562:Electrocardiography; D017809:Fatal Outcome; D005355:Fibrosis / Q000473:pathology; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000209:etiology / Q000473:pathology; D009205:Myocarditis / Q000150:complications / Q000473:pathology* / Q000503:physiopathology*; D012770:Shock, Cardiogenic / Q000209:etiology; D018487:Ventricular Dysfunction, Left / Q000473:pathology