1Depertment of Internal Medicine Shikoku Central Hospital, 2Division of Cardiology, and Clinical Research, Zentsuji National Hospital
acute myocarditis, diastolic dysfunction of the ventricle, echocardiography, mitral annular velocity, left ventricular inflow velocity
A man aged 27 years was admitted to the hospital because of fever and general fatigue. The electrocardiogram showed abnormal Q wave in leads II, III, and aVF, and poor R-wave progression in leads V3 through V6 at time of admission. The chest roentgenogram showed cardiac enlargement and no pulmonary congestion. Values of GOT (66 IU/l), GPT (54 IU/l), LDH (448 U/l), and CPK (1461 U/l) were markedly elevated. The echocardiogram showed diffuse left ventricular hypertrophy, mild pericardial effusion, and normal left ventricular systolic function (fractional shortening, 33 percent). The ratio of early to late diastolic velocity of left ventricular inflow was 1.95. Early diastolic mitral annular velocity (10 cm/sec) was markedly decreased. Mean right atrial pressure (17 mmHg), right ventricular end-diastolic pressure (20 mmHg), and mean pulmonary capillary wedge pressure (20 mmHg) were elevated at time of admission. Our diagnosis of acute myocarditis was based on the clinical features and histologic findings from the right ventricular myocardium. No significant left ventricular systolic failure was indicated during the clinical course. Symptoms and clinical data were improved after treatment. Most noteworthy, early diastolic mitral annular velocity (23 cm/sec) was markedly increased at time of discharge, even though left ventricular inflow parameters had not changed significantly. We judged this case to be acute myocarditis with predominant diastolic dysfunction of the ventricle. Measurement of mitral annular velocity may be useful for evaluating ventricular diastolic function and clinical status of myocarditis.