Electrocardiographic changes related to hypersecretion of catecholamine in a patient with fulminant hepatitis

A 48 year-old-man, with fulminant hepatitis complicated with myocarditis was treated. Despite intensive care, he died of fulminant hepatitis associated with hepatitis B virus infection. Electrocardiography (ECG) showed myocardial infarction-like changes when he went into a deep coma. Microscopically, scattered foci of myocardial cell damage and cell death associated with clusters of inflammatory cells were present in the heart at autopsy. However, there were no findings related to myocardial infarction and staining for hepatitis B surface antigen and core antigen were nil. The concentration of plasma catecholamine was elevated concomitantly with high level of ECG changes. We consider that abnormal ECGs may reflect a hypersecretion of catecholamine and suggest that our patient had a catecholamine cardiopathy.