Acute Myocarditis , a Single Center Experience

Background: the clinical manifestation of acute myocarditis(AM) vary from asymptomatic to fulminant or fatal myocarditis.

Methods: Single center registry-based study of 73 consecutive patients admitted to coronay care unit with acute myocarditis during a period of 7 years (2008-2014).

Results: 73 patients with men age of 37.5+15,( range 16-90), 62 patients (85%) were male and 11(15%) were female. 6 patients (8%) had recurrent myocarditis, 46.5% were smokers.

Pericardial involvement was detected in 32 patients(43.8%), on laboratory tests serum troponin T and I were positive in all patients, mean CPK level was 611+375 u/l, CRP 116+55 ngr/l, WBC 12.6+6 x10^3/mm. Electrocardiographic changes were detected in 48 patients(66%), ST-segment elevation in 33(45%), ST depression and T wave inversion in 15(21%).15 patients with ST-elevation had coronary angiography that excluded coronary obstruction in all patients. Routine echocardiography was performed in all patients: LVEF 53.6+8%, pericardial effusion was found in 21 patients ( 28.8%). Routine laboratory tests for serology was taken in all patients, only three of them found to be positive, for EBV, Brucella and Q fever. One patient underwent endomyocardial biopsy and revealed giant-cell myocarditis. Myocarditis was fulminant in 6 patients(8%), 5 were recovered, 3 of them by ECMO, one patient died.

Conclusion: Acute myocarditis had various clinical manifestation . Most patients were young male , about 50% were smokers. It is common. It remains challenging for doctors to differentiate between acute myocarditis and myocardial infarction, particularly in early stages and ST-segment elevation at presentation.