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Echocardiographic findings in fulminant and acute myocarditis

G. Michael Felker, MD^*, John P. Boehmer, MD, FACC, Ralph H. Hruban, MD, Grover M. Hutchins, MD, Edward K. Kasper, MD, FACC^*, Kenneth L. Baughman, MD, FACC^* and Joshua M. Hare, MD, FACC^*

^* Division of Cardiology, Johns Hopkins Hospital, Baltimore, Maryland, USA
Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland, USA
Division of Cardiology, Hershey Medical Center, Hershey, Pennsylvania, USA

View larger version (17K): [in a new window]   Figure 1 Echocardiographic findings in patients with fulminant and acute myocarditis at baseline and six months. (A) Fractional shortening, (B) left ventricular end-diastolic dimension, (C) septal thickness. *p < 0.01 vs. acute; p < 0.01 for interaction between time and type of myocarditis.

View larger version (82K): [in a new window]   Figure 2 Two-dimensional echocardiograms from patients with fulminant and acute myocarditis at presentation. The top panels show the parasternal long axis (A) and short axis (B) views of a 20-year-old man with fulminant myocarditis who presented after five days of a viral syndrome followed by acute hemodynamic collapse. Note the severe ventricular thickening (septal thickness 2.1 cm) but small ventricular cavity size (LVEDD 2.5 cm). After hemodynamic support with intravenous inotropic agents and a left ventricular assist device, this patient recovered near normal left ventricular function. The bottom panels show parasternal long axis (C) and short axis (D) views from a 19-year-old man with acute myocarditis who presented with three weeks of fatigue, fevers and the gradual onset of dyspnea on exertion. Note the decreased ventricular thickness (septal thickness = 0.6 cm) and marked dilated left ventricular cavity (LVEDD = 6.9 cm). At six month follow-up, LVEDD had increased to 8.0 cm, and the patient was awaiting cardiac transplantation. LVEDD = left ventricular diastolic dimension.

View larger version (125K): [in a new window]   Figure 3 Endomyocardial biopsy specimens from patients with fulminant (A) and acute (B) myocarditis. Fulminant myocarditis was characterized by more extensive and diffuse lympocytic infiltration and myocyte necrosis than acute myocarditis (hematoxylin-eosin stain, original magnification x 400).