Myocarditis as a cause of primary right ventricular failure

Patients with cardiomyopathy secondary to inflammatory myocarditis usually present with biventricular signs and symptoms. On occasion, the disease may progress focally, with left ventricular involvement predominating. This patient had elevated neck veins, edema, and a dilated right ventricle in the absence of left ventricular abnormalities. At autopsy, diffuse, transmural fibrosis of the right ventricle was found, consistent with end-stage myocarditis, with minimal disease of the left ventricle. This case emphasizes that the clinical manifestations of myocarditis can be limited to the right ventricle and should be considered in the differential diagnosis of right ventricular failure.