RESUMO
PURPOSE: In the current study we analyzed clinical evolution and therapeutic aspects of malignant diphtheric myocarditis. METHODS: Fourteen patients with primary diagnosis of diphtheria were prospectively evaluated. Cardiac involvement was detected after 11.5 (mean) days. The diagnosis of diphtheric myocarditis was done in clinical basis. RESULTS: Seven (50%) patients died. Cardiac failure was a common finding in all cases. Complete A-V block was identified in eight (57%) patients. Temporary pacemaker was implanted in 10 cases, six of them died due to myocardial failure. Definitive pacemaker was necessary in two patients with persistent complete A-V block after one-month follow-up. One patient with atrial fibrillation died with sepsis. Respiratory infection was the commonest extracardiac complication (six cases) and two patients developed Guillain-Barré syndrome. We also identified neurologic, renal and adrenal complications. CONCLUSION: Cardiac rhythm disturbances in diphtheric myocarditis are associated with high probability of necessity of temporary pacemaker and high mortality. Definitive pacemaker can be implanted in persistent complete A-V block.
