Difficulties in the diagnosis of myocarditis –case report

Myocarditis is an elusive illness to study, diagnose and treat because the clinical presentation may range from nearly asymptomatic to overt heart failure. A 61 years old female developed fever with chills and rigors during a pilgrimage. After returning, she developed shortness of breath, with retrosternal chest pain and admitted to Teaching Hospital Karapitiya. An E.C.G. (Echocardiography) showed ST elevation in V1 – V6 and ST depression in II, III and AVF leads. The patient was treated as having an acute anterior ST elevation MI (myocardial infarction) treated with heparin and anti anginal drugs. The patient died about six hours after the admission. At the post-mortem, heart appeared flabby with 30% occlusion of the left coronary artery. Histopathology examination revealed acute myocarditis. Many secondary causes can lead to inflammation of the myocardium and therefore the diagnosis of myocarditis cannot be made by evidence of inflammation of the myocardium alone. Therefore, unless multiple, florid foci are found with myofibril necrosis, bland mononuclear foci that are purely interstitial and not involving muscle fibers must be disregarded.