治癒遷延した急性突発性心筋炎の2症例 : 発症前より長期にわたる経過観察

概要

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Two cases with idiopathic acute myocarditis followed by chronic congestive heart failure after acute inflammatory stage were reported. Case 1 was 47 year old male and case 2 was 45 year old male. Both patients showed acute cardiac dilation with inflammatory signs which were initiated by acute pharyngitis and pneumonia. Serological tests for viral infection were repeated, however the results were all negative, and the diagnosis of idiopathic acute myocarditis was made. For 3 and 5 months after disappearllnce of inflammatory sings enlarged cardiothoracic ratio (CTR) recovered from 0.65 to 0.52 in case 1 and from 0.58 to 0.52 in case 2 respectively. However, CTR reincreased to 0.69 in case 1 and to 0.6 in case 2 associated with congestive heart failure. In general, the prognosis of acute viral or idiopathic myocarditis is benign if the patient survived for the acute inflammatory stage. On the other hand it is known that there are chronic pernicious myocarditis with fairly high incidence among the patients showing the clinical feature like a congestive cardiomyopathy. These reported two cases are interesting because their clinical courses suggest the natural history of chronic pernicious myocarditis.
神戸大学の論文