Primary Myocardial Disease

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Abstract
Twenty-nine autopsied cases of primary myocardial disease (myocardiopathy) are reviewed. The disorder is not rare; a number of new cases are observed each year at the University of Cincinnati Hospitals. The cause is unknown. The following factors deserve consideration: familial disease, antecedent infectious myocarditis, alcoholism, beriberi, liver disease, pregnancy, auto-immune disease, and myocardial metabolic disorder. Murmurs of mitral and of tricuspid insufficiency often cause a misdiagnosis of rheumatic heart disease; ecg evidence of bundle branch block or pathologic Q waves frequently cause a misdiagnosis of coronary artery disease. Hypertensive heart disease or pericardial disease or pericardial disease are common erroneous diagnoses. Atrial fibrillation occurred in 1/3. Five had systemic arterial embolism and 6 had pulmonary embolism. The patients were from 18 months to 68 years old at death. Thirteen survived 5 years or more after the onset of heart failure. The treatment is not specific, but may be considered as follows: management of congestive heart failure; prolonged bed rest; anticoagulant therapy; adrenal steroids; surgical relief of outflow tract obstruction.

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