Coxsackie virus infections in patients with acute cardiac disease and chest pain

During 1964 and 1965 infections with Coxsackie virus types A4, B1, B2, B4 or B5 were diagnosed in 9 cases of acute pericarditis ( 2 with myocarditis), 1 of acute myocarditis, 8 of Bornholm disease and 1 of acute chest pain attributed to myocardial ischaemia. Echovirus 6 was isolated from a case of Bornholm disease with antibody response to Coxsackie B 1 virus. Echovirus type 25 was isolated from an additional case of acute myocarditis.

During epidemics Coxsackie viruses probably contribute significantly to acute cardiac disease. The virological diagnosis is often difficult to achieve, and it is important to attempt virus isolation from early specimens in addition to testing paired sera.

The cardiovascular system in acute infectious disease

Myocarditis may result from a wide variety of acute infectious diseases, but electrocardiographic abnormalities interpreted as indicating myocarditis may arise from a number of other causes. Among the factors which may cause myocarditis are direct invasion by an organism, the toxic products of an organism, hypersensitivity to the products of an organism, drugs used in therapy, deficiency in nutrients, electrolyte imbalance, and, rarely, fever. Recently emphasis has been placed on the finding that circulatory failure in acute infectious diseases is often primarily peripheral, although heart failure due to myocarditis is not uncommon.