Myocarditis in senescence

Myocarditis is not rate in the aged. Among 1,629 consecutive autopsies of patients over the age of 60, there were 23 cases of myocarditis, an incidence of 1.4 per cent. Among 925 autopsies of patients 70 years and older, myocarditis was found 13 times (1.4 per cent). Most patients had cardiovascular symptoms which were diagnosed as acute myocardial infarction. All patients had characteristic clinical signs which, in retrospect, could be interpreted as having been caused by myocarditis. Comparing the degree of coronary artery disease and resulting myocardial changes with the degree and extent of the myocarditides, we believe that myocarditis was the main cause of death in 10 patients, and that it played a contributing role in the death of 7 patients. It was an incidental finding in 6 patients. Four myocarditides were typical of hypersensitivity, and 2 were due to a toxic substance, norepinephrine. These cases were discussed in more detail. Eight patients had evidence of old myocardial infarction or scattered fibrosis of the myocardium. In all hearts the anatomic changes due to coronary artery disease and infarction were distinct from the lesions of myocarditis. It was stressed that myocarditis is a specific entity of old age, as it is in younger individuals, that on critical evaluation of the patient the characteristic signs may be present, and that hypersensitivity plays an important role in the myocarditis of the aged.