Studies in Myocarditis

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Abstract
A review is given of 252 cases of myocarditis and myo-pericarditis treated in a department of internal medicine during the years 1940 to 1959. The etiologic disease was rheumatic fever in 38 cases, collagenosis and other immunopathies in 40 cases and various infectious diseases in 89 cases. The etiology was unknown in 51 cases. This last group presented a different clinical picture, there being acute cases often complicated by pericarditis with as a rule rapid regression of the ecg changes, and cases of insidious onset without pericarditis and with persistent ecg changes. It is suggested that viral diseases and immunopathies may be factors of importance in these different types of myocarditis. The ecg at rest was a reliable diagnostic criterion of myocarditis. Work ecg is a more refined diagnostic method than ecg at rest and was still abnormal in some cases when the ecg changes at rest had disappeared. Work test was performed after the most acute phase of the disease in 40 cases and showed normal physical working capacity in about half of the patients. X-ray is a valuable diagnostic and prognostic guide, as more severe cases showed enlargement of the heart. The greatly varying clinical importance, course and prognosis of the myocarditis is elucidated. The majority of cases ran an acute, rather benign course with complete regression of signs and symptoms within 6 months after discharge from hospital, but 5% of the total case material died due to the myocarditis, most of them with intractable heart failure.