Diagnosing myocarditis

To diagnose myocarditis, more than just an ECG is needed.
To diagnose myocarditis, more than just an ECG is needed.

I just read an article from December 2014 ("Misdiagnosis leads to fatal emergency"). It was about a case of a young man who died of myocarditis, and the summary seemed to conclude that the case was won on the fact that an ECG was not done, which would have made the diagnosis of myocarditis.


The most common finding on an ECG for myocarditis is nonspecific ST and T-wave changes, and in no way cinches a diagnosis. (Diffuse ST elevation can suggest pericarditis, but this is by no means universal.) Myocarditis is a difficult diagnosis to make, and a constellation of signs, symptoms, and tests needs to be performed to accurately make a diagnosis. I think the article is misleading in suggesting that a simple ECG could have led the provider to the correct diagnosis and obviated this young man's death.


A point of the article was that he complained of chest pain, and therefore an ECG was reasonable to do (but not unreasonable not to, if other respiratory symptoms were more prominent), but no one should be led to conclude that an ECG can diagnose myocarditis — the only definitive way to do that is myocardial biopsy. — VICTORIA BOISEN, DO, Medford, Oreg. (201-4)



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