馬場 雄治¹, 小西 弘起¹, 瓦谷 仁志¹, 竹本 和司²

Yuji BABA¹, Hiroki KONISHI¹, Hitoshi KAWARATANI¹, Kazushi TAKEMOTO²

¹大阪府済生会野江病院　循環器科, ²徳州会岸和田病院　臨床検査室

¹Department of Cardiology, Osaka Saiseikai Noe Hospital, ²Department of Clinical Laboratory, Tokushyukai Kishiwada Hospital

キーワード : Acute myocarditis, Echocardiography, Clinical stages

Serial two-dimensional and M mode echocardiography was performed on 3 patients with severe acute infectious myocarditis. The patients included 1 female and 2 males aged 38, 55, 70 years. All patients had prodromal symptoms, increased serum cardiac enzyme levels, A-V block, widespread ST elevation in electrocardiograms, and were entering cardiogenic shock. VVI pacing and intraaortic balloon pumping were performed on 2 patients resulting in complete recovery. Coronary angiography and endomyocardial biopsies were performed on 2 patients with normal coronary anatomies and histopathological findings compatible with healing acute myocarditis. Echocardiographic examination was begun within a week of onset of prodromal symptoms in each case. Case 1 showed transient asymmetric septal hypertrophy which normalized later. Case 2 initially exhibited marked left ventricular hypertrophy, followed by a transient decrease of left ventricular wall thickness, and finally recurrence of left ventricular hypertrophy. Case 3 showed no hypertrophy, but mild dilatation of the left ventricle and impaired left ventricular wall motion which later improved. These findings suggest that echocardiographic features in acute infectious myocarditis differ in each case, and change markedly with clinical stages.