THE CLINICAL PICTURE AND DIAGNOSIS OF DIPHTHERITIC CARDITIS IN CHILDREN

During 1992-1996 we observed 122 children with diphtheria, 49 with the toxic form, in the region of Nizhny Novgorod in Russia. Sixty-four pa tients suffered from diphtheric carditis, 9 died. The clinical picture was characterized by a rapid development of heart and circulatory fai lure. ECG showed QR alterations with intraventricular conduction impai rment, sinus node dysfunction, ectopic rhythm disturbances and repolar ization disturbances in all patients with carditis. Infarction-like EC G changes were typical for the pseudocoronary form with the worst prog nosis. Echocardiographically there was left ventricular (LV) dilatatio n and depressed LV function, whereas LV muscle mass was increased. Myo globin, LDH and CPK levels were elevated in each patient demonstrating significant differences between the various courses of disease. Concl usion In diphtheria. the extent of hypermyoglobinaemia ( > 2000 ng/ml) and an increased LDH1/LDH2 ( > 1) ratio are reliable markers for the development of carditis indicating a poor prognosis.