Congestive Heart Failure in Diphtheric Myocarditis

A. M. Prasodo; M. Narendra; A. Joernil; Wahjoenarso Wahjoenarso; F. Kaspan

doi:10.14238/pi16.3-4.1976.71-80

A. M. Prasodo and Department of Child Health, Universitas Airlangga Medical School/Dr. Soetomo General Hospital, Surabaya, East Java
M. Narendra and Department of Child Health, Universitas Airlangga Medical School/Dr. Soetomo General Hospital, Surabaya, East Java
A. Joernil and Department of Child Health, Universitas Airlangga Medical School/Dr. Soetomo General Hospital, Surabaya, East Java
Wahjoenarso Wahjoenarso and Department of Child Health, Universitas Airlangga Medical School/Dr. Soetomo General Hospital, Surabaya, East Java
F. Kaspan and Department of Child Health, Universitas Airlangga Medical School/Dr. Soetomo General Hospital, Surabaya, East Java

DOI: https://doi.org/10.14238/pi16.3-4.1976.71-80

Keywords: congestive heart failure; diphtheric myocarditis; hepatic enlargement; epigastric pain; dyspnea

Abstract

The picture of congestive heart failure in diphtheric myocarditis was mainly determined by poor general condition, hepatic enlargement + epigastric pain, dyspnea. Basal rales and peripheral edema were not observed. Cardiomegaly on X-ray examination supported the diagnosis.

Congestive heart failure as a complication of diphtheric myocarditis occurred in 31.2% - 52% of cases with severe ECG changes and only in 5% of cases with ST depression or T wave changes.

Of 29 cases with congestive heart failure only 3 survived. Apparently good results of digitalis treatment were obtained when only gallop rhythm, as an early sign of heart failure, was found.

Extensive myocardial damage by diphtheria toxin may explain why no beneficial effect of digitalis treatment was obtained. Prophylactic digitalization before signs of congestive heart failure appeared, as suggested by several authors; was not performed in this study.

References

1. BARNETT, H.L. and EINHORN, A.H.: Pediatrics, 14 th ed. p. 588 - 589, 1212 (Appleton - Century -
Crofts, New York 1968).
2. BURCH, G.E., SHIN-CHIEN, S., SOHAL, R.S., KANG, C.C. and COLCALOUGH, H.L. : Diphtheric myocarditis,
a histochemical and electron microscopic study. Am. J. Cardiol. 21 : 261 (1968).
3. FRIEDMAN, F.W., LESCH, M. and SONNENBLEEK, E.H. : Progress in Cardiovascular Diseases, Neonatal
Heart Disease pp. 215 - 217 ( Grunne & Stratton, New York 1973).
4. GILLIS, G. and KAGAN : Current Pediatric Therapy. 5th Ed p. 557 (Saunders, Philadelphia 1971).
5. HUGHES, G.J. : Diphtheria, Synopsis Pediatr. 2nd ed. p. 714 - 718 (Mosby, Saint Louis 1967).
6. KEMPE, C.H., SILVER, H.K. and O'BRIEN, D.: Current Pedirutrio Diagnosis & Treatment, ed. p. 580
(Lange. Mecl. Publ., Los Altos 1970).
7. KWARI, S., YAP, K.N. and THE, S.L.: Clinical study of diphtheria with special reference to cardiac complications. Paediatr. Indones. 5 : 928 (1965).
8. Me. NAMARA, D.G. : Recognition of Congestive Heart Failure. Pediatr. Clin. N. Amer. Pediatr. Cardiol., 18 : 1197 (1971).
9. MORGAN, B.C.: Cardiac complications of diphtheria. Pediatr. 32 : 549 (1963).
10. NADAS, F.: Pediatric Cardiology, 3rd ed. p. 236 (Saunders, Philadelphia 1972).
11. NELSON, W.E., VAUGHAN, V.C. and Me. KAY, R.J.: Textboolt of Pediatrics, 9th Ed., (Saunders, Philadelphia 1969).
12. WATSON, H.: Pediatric Cardiology, 1st ed. pp. 868 (Mosby, Saint Louts 1968).
13. YAP, K.N. and THE, S.L.: Diphtheria, M.I.P.I. Congr., Yogyakarta, October, 1962.