Læknablaðið - 15.02.1990, Blaðsíða 25

LÆKNABLAÐIÐ
99
einnig frá gáttum. Alvarlegustu fylgikvillar
sjúkdómsins þ.e. sleglaflökt, kom fyrir í tveim
ungum mönnum eftir þátttöku í knattleikjum.
Við krufningu þess sem lést sáust breytingar
er gátu samrýmst bólgu í hjartavöðva svo
og brjósthimnu. Ef til vill ætti fólk sem
fær slæm öndunarfæreinkenni með hita,
vöðvaverkjum og brjóstverkjum, ekki að
taka þátt í keppnisíþróttum eða leggja á sig
verulegt erfiði næstu vikumar (5, 15).
Eins og fram hefur komið er greining
bráðabólgu í hjarta oft torveld. Oft er
sjúkdómurinn vægur og einkenni likjast
gjama öndunarfærasýkingu sem reyndar er
oft meðfylgjandi.
Orsök sjúkdómsins er í flestum tilfellum
talin vera veirusýking og var svo nokkuð
örugglega í einum sjúklinganna en tókst ekki
að staðfesta í hinum. Ljóst er að veirusýking
sem leggst á hjartavöðvann getur haft
alvarlegar afleiðingar í för með sér svo sem
hjartabilun og jafnvel dauða. Einnig þykir víst
að bólgan geti stundum verið viðvarandi og
valdið blóðríkishjartavöðvakvillum (congestive
cardiomyopathy) (1, 5, 6, 16).
SUMMARY
In 1985 and 1986 seven patients (6 men, 1 woman;
mean age 28.8 years) were admitted to the City
Hospital in Reykjavik (Borgarspítalinn) with
probable myocarditis. The most serious acute
complications occurred in two young men after
participating in active sport. One of them arrested
while playing soccer and could not be resuscitated.
Autopsy revealed enlarged heart, no significant
coronary artery disease, and histology consistent
with myocarditis. The other patient developed
acute pulmonary edema shortly after playing and
arrested as well after admission. After resuscitation
it was obvious he had sustained embolic stroke
and left hemiparesis. Cardiac and neurologic
function improved markedly over the next few
months and cardiac catheterization showed no
coronary artery disease. The third patient, 27 years
old man, who previously had normal exercise
tolerance was admitted in congestive heart failure.
Gallium scan showed increased uptake suggestive
of inflammation of the heart. He had frequent
ventricular arrhythmias and needed amiodarone
treatment as well as therapy for congestive heart
failure. He died two years later. Autopsy revealed
cardiomegaly, myocardial fibrosis but no coronary
artery disease consistent with healed myocarditis.
In two other patients no coronary artery disease
was seen but one of them had severely reduced
myocardial function with ejection fraction of only
20%. This patient was the only one of these seven
who did not have elevated cardiac isoenzymes
but he had been ill for a week before admission.
Two of the patients recovered completely and had
no complications or further evidence of cardiac
disease. An effort was made to confirm likely viral
etiology in these patients but was successfully done
in only one of them.
HEIMILDIR
1. Goodwin JF. Summary of Workshop In Bolte H D
(ed). Viral heart disease. Berlin, Springer-Verlag
1984; 234-9.
2. Aretz HT. Diagnosis of Myocarditis by
endomyocardial Biopsy. Med Clin North Am 1986;
70: 1215-26.
3. Mason JW. Endomyocardial biopsy: The balance of
success and failure. Circulation 1985; 71: 185-8.
4. O’Connell JB, Robinson JA, Henkin RE, Gunnar
RM. Immunosuppressive Therapy in Patients with
Congestive Cardiomyopathy and Myocardial uptake
of Gallium-67. Circulation 1981; 64: 780-6.
5. Kereiakes DJ, Parmley WW. Myocarditis and
cardiomyopathy. Am Heart J 1984; 108: 1318-26.
6. MacArthur CGC, Tarin D, Goodwin JF, Hallide-
Smith KA. The relationship of myocarditis to dilated
cardiomyopathy. Eur Heart J 1984; 5: 1023-35.
7. Wenger N.K. Myocarditis Current Opinion in
Cardiology 1987; 2(3), 527-31.
8. Vikerfors T, Stjema A, Olcén P, Malmcrona R,
Magnius L. Acut Myocarditis Acta Med Scand 1988;
223: 45-52.
9. Heikkila J, Karjalainen J. Evaluation of mild acute
infectious myocarditis. Br Heart J 1982; 47: 381-91.
10. Billingham M. Acute myocarditis: a diagnostic
dilemma. Br Heart J 1987; 58: 6-8.
11. Lie JT. Myocarditis and Endomyocardial Biopsy in
Unexplained Heart Failure: A Diagnosis in Search of
a Disease. Ann Intem Med 1988; 109: 525-8.
12. Chow LC, Dittrich HC, Shabetai R. Endomyocardial
Biopsy in Patients with Unexplained Congestive
Heart Failure. Ann Intem Med 1988; 109: 535-9.
13. Shabetai R. Cardiomyopathy: How Far Have We
Come in 25 Years, How Far Yet to Go. J AM Coll
Cardiol 1983; 1:252-63.
14. O’Neill D, McArthur JD, Kennedy JA, Clements G.
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1985; 61: 485-8.
15. Neuspiel DR. Sudden death from myocaditis in young
athletes. Mayo Clin Proc 1986; 61: 226-7.
16. Dec GW, Palacios IF, Fallon JT, Aretz HT, Mills
J, Lee DCS, Johnson RA. Active myocarditis in the
spectrum of acut dilated cardiomyopathies. N Engl J
Med 1985; 312(|4): 885-90.
17. Aretz HT. Myocarditis: The Dallas Criteria. Hum
Pathol 1987; 18(6): 619-24.