Myocarditis confirmed by biopsy presenting as acute myocardial infarction.

Sir, We were very interested to read the report by Costanzo-Nordin etal in the January 1985 issue of the British Heart journal of two cases of myocarditis confirmed by biopsy which presented as acute myocardial infarction.1 In April 1984 we reported on two similar cases in Archives des Maladies du Coeur.' These occurred in a 31 year old woman and a 37 year old man who were referred to our intensive care unit with the diagnosis of acute anterior myocardial infarction. In both cases acute cardiogenic shock with diastolic equalisation of pressure lead us to the incorrect diagnosis of heart rupture. But in both cases cardiac catheterisation showed normal coronary arteries, and the acute myocarditis that we diagnosed healed without any sequelae (normal electrocardiogram, echocardiography, and angiography). In the male patient the diagnosis was based on serological investigation which showed a high and increasing titre of Chlamydia trachomatis. We recognise that cardiac biopsy cannot be performed during the subacute stage of the disease, but we agree with Costanzo-Nordin et al that biopsy may be useful in identifying myocarditis that is associated with or simulates acute myocardial infarction.