• H W Versteeg, Jan C W van Zwienen, T Gilles M van Delft, and Pieter J Wismans.
• Havenziekenhuis, afd. Interne geneeskunde en Cardiologie, Rotterdam.
• Ned Tijdschr Geneeskd. 2019 May 9; 163.

AbstractMyocarditis, a treacherous condition It is important to recognize myocarditis at an early stage. To illustrate this, we present two male patients aged 39 and 51, respectively, who were admitted with febrile disease and signs of circulatory instability. Initially, myocarditis was not suspected in these patients. After the sudden death of the younger patient it was discovered that he had had fulminant myocarditis. Its nonspecific, heterogeneous clinical presentation, and potentially disastrous outcome make myocarditis a treacherous condition, which mainly affects younger adults. Although its aetiology is broad, the primary cause in the western world is a viral infection leading to lymphocytic myocarditis. Fulminant forms are rare, but this diagnosis needs to be considered in patients with an atypical illness and impaired haemodynamics or electrocardiogram (ECG) abnormalities. Early and liberal consultation of a cardiologist is important. Primary diagnostics include blood testing (e.g. troponin, creatinine kinase), ECG, echocardiography and exclusion of coronary ischaemia. The diagnosis can be confirmed by cardiovascular MRI or endomyocardial biopsy.

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