[Acute idiopathic myocarditis having myocardial inflammatory swelling demonstrated by echocardiography: a case...

A case of acute idiopathic myopericarditis with transient severe swelling and akinesis of the interventricular septum on echocardiograms was reported. A 35-year-old man was admitted to our CCU because of cardiogenic shock five days after the onset of "common cold". Electrocardiograms revealed low voltage and ST-segment elevation in all leads except for a VR and a VL. Serum CPK, GOT and LDH were slightly elevated. Echocardiograms showed severe asymmetrical septal hypertrophy (ASH, 20 mm), akinesis of the interventricular septum and moderate pericardial effusion. With improvement of the clinical course and of the hemodynamic data, the thickness and wall motion of the interventricular septum became normal. Serum antiviral antibodies were not elevated throughout the course. Transvenous percutaneous right ventricular endomyocardial biopsy revealed degeneration and fragmentation of the myofibrils with interstitial cellular infiltration and edema in the subacute phase (8th hospital day), but showed only focal fibrosis in the chronic phase. Coronary arteriograms and left ventriculograms in the chronic phase (50th hospital day) were normal. From these findings we can conclude that the severe transient ASH is due to myocardial inflammatory swelling.