Myocarditis as a Cause of Sudden Death

To the Editor: We appreciated the outstanding review by Drs Zipes and Wellens on sudden cardiac death.1 However, the authors did not mention myocarditis as a cause of sudden death. In our experience at the Forensic Institute of Paris, myocarditis accounts for ≈5% of sudden, out-of-hospital cardiac deaths.2 Two patterns are common. Acute myocarditis, the first type, occurs most frequently in children or young adults. The diagnosis is likely to be overlooked because of the frequent lack of symptoms. When present, symptoms are not specific; they suggest a bad cold in most instances. The heart is grossly normal. In particular, it is not enlarged. Myocyte necrosis and inflammatory …