ELEVATION OF ALT TO AST RATIO IN PATIENTS WITH ENTEROVIRAL MYOCARDITIS

Enteroviral myocarditis is often a relatively benign condition in adul ts. Physicians, therefore, may not always record detailed clinical and laboratory data in such patients. As such, they may not recognize vir al involvement in organs beyond the heart. The purpose of this study w as to examine the hepatic involvement of enteroviral peri-myocarditis and to compare the other diseases with congestive heart failure. We an alyzed 18 patients (ages 15-64) who were diagnosed as having enterovir al myocarditis (n=16) or pericarditis (n=2). Serology was positive for coxsackie viruses in 11 patients and echoviruses in six patients. A d iagnosis of hepatic involvement was made by the following laboratory d ata: rising levels of alanine amino transferase (ALT), aspartate amino transferase (AST) and exceeded serum ALT compared with AST levels. A ratio of ALT/AST more than 1.0 was greatly frequent in patients with p eri-myocarditis (72%; 13/18) compared with acute myocardial infarction (0%; 0/10) and idiopathic dilated cardiomyopathy (3%; 3/10). In summa ry, hepatic involvement in the setting of acute enteroviral peri-myoca rditis may be considerably more common in adults than previously suspe cted. The recognition of hepatic involvement in association with enter oviral peri-myocarditis may allow improvement of diagnostic sensitivit y and alter approaches to treatments of acute viral myocarditis.