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Fatal myocarditis: morphologic and clinical features.

Elisa Carniel1, Gianfranco Sinagra, Rossana Bussani

  • 1Department of Cardiology, University of Trieste, Trieste, Italy. elisacarniel@hotmail.com

Italian Heart Journal : Official Journal of the Italian Federation of Cardiology
|December 1, 2004
PubMed
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Fatal myocarditis is often undiagnosed, especially in young individuals. This autopsy study found active myocarditis as the cause of death in 1.5% of cases, highlighting the need for increased clinical suspicion for this potentially fatal disease.

Area of Science:

  • Cardiology
  • Pathology
  • Forensic Medicine

Background:

  • Myocarditis prevalence varies widely, from 0.11% in the general population to nearly 50% in specific groups.
  • Myocarditis is frequently undiagnosed, and its fatality rate remains unevaluated.
  • This study aimed to determine the frequency of fatal myocarditis in autopsies and characterize its clinical, histological, and morphological features.

Purpose of the Study:

  • To assess the frequency of fatal myocarditis in a consecutive autopsy series.
  • To describe the clinical, histological, and morphological characteristics of fatal myocarditis.
  • To emphasize the underdiagnosis of myocarditis and the need for early clinical suspicion.

Main Methods:

  • A total of 2560 autopsies were performed between January 1, 1995, and January 31, 1996.

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  • Active myocarditis was diagnosed in 143 cases (5.6%).
  • Fatal myocarditis was identified as the final cause of death in 39 cases (1.5%).

    • Main Results:

    • Active myocarditis was the cause of death in 1.5% of autopsies (39/2560 cases), with 12 males and 4 cases in individuals aged 35 or younger.
    • Myocarditis was suspected ante-mortem in only one case.
    • Histologically, lymphocytic infiltration was most common (64%), followed by mixed (33%) and granulomatous (3%). Myocarditis affected both ventricles and the septum in 49% of cases.
    • Clinical presentations included heart failure (46%), cardiac arrest (10%), syncope, and chest pain (3%).
    • Biochemical and electrocardiographic findings were often non-specific, and echocardiography revealed ventricular dysfunction in 71% of examined cases.

    Conclusions:

    • Myocarditis is significantly underdiagnosed before death.
    • A high index of clinical suspicion is crucial for timely diagnosis and treatment.
    • Fatal myocarditis affects individuals across various age groups, including the young, necessitating prompt medical attention.