Primary Myocardial Disease

Abstract

Twenty-two males with idiopathic cardiomegaly and heart failure due to a primary myocardial fault are reported. Fourteen were Negro, the hospital population being 18% Negro. Twenty-one ingested ethanol in excess. The average age of onset was 43 years. The ECG was invariably abnormal but not diagnostic. The most frequent patterns were left ventricular hypertrophy, intraventricular or bundle branch block, low voltage, and T wave inversion. Atrial fibrillation and premature ventricular systoles were the commonest arrhythmias. The chest roentgenogram frequently suggested pericardial effusion. Patients usually survived the first episode of heart failure but frequently had repeated episodes with a progressive course of cardiac deterioration. Sudden death was also common. Peripheral embolization was recognized in 37%. Postmortem examination in 9 of the 12 dead revealed right and left ventricular hypertrophy, the average weight being 617 g. Microscopic examination showed hypertrophy and interstitial fibrosis. Multicausal factors are thought to result in a primary myocardial fault, all of which present a similar clinical, roentgenological, ECG, and pathologic picture.