Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
Beverly C. Morgan
Pediatrics 1963;32;549
The online version of this article, along with updated information and services, is located on
the World Wide Web at:
http://pediatrics.aappublications.org/content/32/4/549
PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly publication,
it has been published continuously since 1948. PEDIATRICS is owned, published, and trademarked
by the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village,
Illinois, 60007. Copyright 1963 by the American Academy of Pediatrics. All rights reserved. Print
ISSN: 0031-4005. Online ISSN: 1098-4275.
CARDIAC
COMPLICATIONS
Beverly
Station
Heart
and
HE
routine
WIDESPREAD
C. Morgan,
Department
immunization
diphtheria,
and smallpox
pertussis,
has re-
sulted
decrease
the
dence
marked
of these
current
diseases
in the
textbook
United
of pediatric
comments
: Since
the
eliminated
almost
totally
an opportunity
in
is rarely
presented.
world,
however,
and
98
recently
States.2
by
to the
The
In other
even
in
parts
certain
Robert
to
determine
ment,
incidence,
efficacy
prognosis
this disease.
of
of
the
During
1957,
the
cardiac
with
diphtheria
Green
Memorial
county
with
while
history
period,
30,
98
1,
patients
were
evaluated
dead
on
postmortem
There
were
American.
were
and
tion
three
patients;
Negro
the
Forty-nine
male.
Three
rubeola
ranged
of
February
the
98
had
The
months
18; accepted
three
were
children
concurrenfly.
from
14
(Received
and
remainder
for
study
analysis.
after
95
cases)
had
was
positive
diph-
chest
of
In
x-ray
availadmitted
1960,
(42
to
of
electrocardiograms
day
following
during
tracings
discharge
electrocardiograms
obtained
for
from
The
Cau-
and
patients
all
but
1 month
duration
fever,
several
shortness
diphtheria
age distributo 17 years.
of Pediatrics,
All patients
November
15,
serial
the
the type
available.
had
hospitaliza1, 2, and
from
the
hos-
were
12 or
13
April
from
often
patients
and
ranged
from
FINDINGS
of
symptoms
with
prior
that
swelling
to admission.
of sore
throat
of the
neck;
patients,
in addition,
complained
of
of breath.
On physical
examina-
tion
all
ings
compatible
children
6, 1963.)
the National
University
six
to 5 years.
a few hours
to 11 days
The
usual
history
was
Latin
by a grant
met
nasopharyn-
electrocardiograms
CLINICAL
of
for publication
more
every
other
and
additional
ranged
diphtheria.
casian
able
the
study
regarding
was
not
patient
or
arrival
findings
this
positive
had
patients
lead
tracings
obtained
on a Sanbom
Twin
Beam
photographic
machine
except
for the
bedside
records
which
were
taken
with
a
Cambridge
Simple-Scribe
direct
writing
instrument.
Post-hospitalization
follow-up
at the Robert
B.
a 330-bed
city-
were
each
one
All
in
ap-
two
95
diphtheria,
(2)
Corynebacterium
for
and
pital.
in
in
for
only
The
( 1)
Information
organism
months
and
Ninety-five
included
smear
culture
taken
tion
of these
criteria:
addition,
involve-
January
1962,
booster
theriae.
diptheria
the
three
and
geal
throat
METHODS
were
seen
Hospital,
hospital.
clinically,
were
following
complications
AND
June
who
heart
treatment,
5%-year
through
injection.
reviewed
of
type
modern
MATERIAL
and
of the
areas
school
age;
children
contracted
their
diphtheria
from
siblings.
Only
five patients
had
a basic
series
of three
diphtheria
had
admitted
Hospital.
were
were
of
younger
the
immunizations,
sections
of
5%-year-period,
findings
age
B. Green
been
communicommon.
actually
in-
with
cardiovascular
parently
school
received
immunization,
diphtheria
were
B. Green
Memorial
patients
patients
10 of
States.
a diphtheritic
in some
In the past
Sixty-nine
addition,
mci-
has
of the United
States,
preventable
cable
diseases
remain
relatively
Diphtheria
attack
rates
have
creased
United
Robert
Texas
cardiology
infection
to study
San Antonio,
of
children
against
tetanus,
poliomyelitis,
in
M.D.
of Pediatrics,
Hospital,
Memorial
OF DIPHTHERIA
had
nasopharyngeal
with
Heart
of Washington
diphtheria,
Institute,
School
Public
findincluding
Health
of Medicine,
Service
Seattle
Washington.
PEDIATRICS,
October
1983
549
1)1 PHTI-IERIA
550
TABLE
peared
ELucraocutDIooItAiuIc
FINDINUN
95 PATIENTS
WITH
Patients
These
with
T-wave
changes
Died
vere myocarditis
Three
of these
ST-segmentshift
Minor
P-wave
more than
abnormality
1 mm
14
Prolonged
QT
interval
Prolonged
PR
interval
in
regularity
during
Atrial premature
contractions
Ventricular
premature
contracatrial
rhythm
rhythm
Left
bundle-branch
Right
bundle-branch
dissociation
A-V
block
block
The
electrocardiographic
in 31 patients,
of whom
had
myocarditis.
significant
scribed
in three
rhythm
abnormalities
27 are
and
not
to
formation;
admission
with
ture
elevation.
cient
respiratory
most
variable
degrees
Fifteen
patients
embarrassment
Six
patients
at or soon
developed
one
transient
ocular
tracheostomy
sis
of
the
left
neurological
No
palsy,
abnormality
against
this disease
All patients
were
penicillin
and many
therapy.
theria
antitoxin
all had
treated
received
All
cularly
in
in mild
six
these
were
deaths
to
The
but
intramus-
and
three
of
ap-
other
de-
with-
was
mur-
children
who
or clinical
evi-
and this
become
was
complete
abnormalities
in Table
one
two
right,
had
and
bundle-branch
In addition
atrioventricular
fourth
had
developed
I.
clinical
evideveloped
block;
block,
tion
while
the
heart
block.
One
patient
the
block
observed.
children
with
myocarditis
a right
to left.
showed
heart
otherwise
bundle-branch
had
on
patient
succumbed.
Two
hypotensive
terminally,
not
bundle-branch
steroid
effect
of the four
of
severe
child
received
apparent
disease;
congestive
despite
anti-congestive
also
electrocardiographic
patients
are summarized
terminally
patients
pa-
and
of these
without
shock
complete
units
after
appropriwas administered
in-
both
The
in 95
from
cardiac
in children
in several
carditis
and
of his
diph-
95
present
One
developed
patients
cardiac
Three
seen
were
or distant
while
gallop
Tachycardia
developed
succumbed
observed.
the
sounds
poor,
children,
in one.
were
with
failure
of
mild
diphtheria.
with
parenteral
additional
an-
among
hospital.
Heart
dren
heart
ranging
deaths
the
patients.
ir-
some
time
in each
of
No child
with carditis
time. Two of the chil-
course
immunized
and
at
illness
dence
of myocarditis.
had a murmur
at any
received
cases
occurred
electrocardiographic
therapy
ones.
There
were
tients
admitted
no
doses
severe
which
course
of the
cardiac
or absence
of heart
murmurs
to be helpful.
Physiologic
were
had
patients
in
se-
findings
was
bradycardia
Each
dence
40,000
units
to 80,000
ate skin
testing;
this
travenously
been
of
auscultatory
as indistinct,
of these
four
was observed
measures.
other
examination.
had
electro-
evidence
carditis
digitalization
paralyno
evidence
physical
who
tibiotic
one
were
had
on
children
admission.
paralysis,
hemi-diaphragm;
initially
on
of temperahad
suffito require
and
the
presence
not found
have
febrile
after
palatal
complications
patient
five
were
developed
(case reports
in appendix).
patients
succumbed
while
with
four
murs
membrane
occurred
illness.
out other
evidence
of carditis
as frequently
as in those
who had this complication.
The
occurred
considered
of
pathological
eviover-all
mortality
clinical
frequent
patients
history
diagnostic
survived.
most
these
patients
and
fourth
The
block
heart
Complete
*
the
tions
Nodal
95
cardiographic
18
Low
of
bradycardia
with
findings
64
leads
Sinus
additional
arrival
or more
in
Three
on
postmortem
Four
electrocardiogram
dead
9 of 98 cases)
was 9%. All deaths
within
the first fourteen
days
of
Findings*
Normal
respiratory.
diphtheria
but
without
dence
of myocarditis.
The
Findings
Surrived
be
were
and
DIPHTHERIA
Electrocardiographic
to
patients
IN
left
one
shifting
three
of these
dissociacomplete
electrocardiographic
551
ARTICLES
findings
of particular
evidence
of
girl
Negro
vealing
had
leads
l)lane;
interval.
in
1960,
1962.
In
of
for
the
There
of
the
in Novemin August,
of
findings
were
not thought
episode
of diphtheria.
to
no other
normal
other
major
deviations
observed
cases,
bradycardia,
electrocardio-
Minor
were
additional
atrial
transiently
and
premature
premature
in
included
sinus
1:
contractions,
contractions,
ST-segment
shifts,
T-wave
OI
more
leads,
minor
P-wave
minor
changes
in
two
abnormalities,
minimal
prolongation
of the PR or QT
(Table
I). Normal
electrocardio-
and
interval
grains
subsequently
No patient
were
these
cal
at
evidence
abnormalities
ventricular
PR
present
her
were
from
in
a prolonged
were
absence
to
graphic
had
diphtheria
still present
were
these
related
re-
of 1 to 2 mm
frontal
and horizontal
she
findings
addition,
admission
carditis,
26
electrocardiograms
in the
and
other
9-year-old
shifts
These
time
l)er,
without
This
serial
ST-segment
lflulti1)le
l)e
interest
myocarditis.
children.
pathological
significant
or
without
obtained
in
all
developed
evidence
of
clini-
of myocarditis
electrocardiographic
changes.
Each
rubeola
of the three
and diphtheria
who
developed
electrocardiographic
minimal
abnormalties.
prolongation
minor
in
frequent
atrial
leads.
both
QT
T-wave
child
and
third
proST-
who
of
who
had
patient
mild
cardiac
cardiac
severe
myoFigs.
1 &
has
enlargement
other
case.
had
regres-
enlargement.
was
Sig-
not
ob-
patient.
in
diphtheria
is due
to
Anteroposterior
admission,
death
lus
film
and
of
(below)
(increased
the
liberated
and
self.
not
The
to
by
the
It is said
of
the
shortly
heart
chest
before
size).
of 496
of
is
reported
with
servers
place
to
be
the
most
disease.
62%
abnormalities
in
from
16.5%
figure
at
the
comparable
the children
abnormalities
is
this
in
cases.#{176}
reported
patients
it-
in about
and
in
bacii-
organism
clinically
death
Electrocardiographic
been
diphtheria
of the
patients
cause
mortality
series
the
effect
to occur
affected
common
figure
COM MENT
Myocarditis
1.
on
exotoxin
in the
changes
in each
cardiomegaly
surviving
in any
obtained
Case
(above)
10%
were
patients
his
1.
FIG.
de-
concurrently
elevation
T-wave
.:
had
minor
child
diseases
ST segment
leads
and
developed
4). The
served
interval
of these
x-rays
four
carditis
nificant
and
leads.
Chest
sion
had
interval,
contractions,
The
developed
mild
mid
precordial
in three
PR
A second
premature
changes.
veloped
One
the
shifts,
two
of the
segment
The
of
ST-segment
changes
longation
had both
transient
children
to the
in
this
in
series
one
or
to
have
84%
of
all
while
most
ob-
about
25%,,
#{176}
a
32%
(31
of 95)
of
who
developed
more
tracings
552
DIPHTHERIA
:::
-:
iIrr
iJ:
I:
4:L
A;1It
i-j
tttt
H ffttLt:i
41#{149}
NL
#{149}
vs
/s
,-.
-
TriI1j:
2.
FIG.
Case
1. Electrocardiogram
tion
Table
graphic
sion
segment
shifts
has
been
1(
have
this
are
probably
of
in
Other
been
6 hours
marked
variation
Prolongation
observed
and
the
the
about
and
ST-
earliest
affected
prolonga-
4$
showing
A-V
dissocia-
tion
of the
low
voltage,
slurring
of the
axis
shift,
bizarre
QT
interval,
sinus
the
more
bradycardia,
QRS
waves,
serious
graphic
abnormalities,
defects
and
arrhythmias
scribed.
Atrial
fibrillation
complexes,
and
have
and
conduction
been
flutter
!i;
L1
-?
I1jl_l
FIG.
3.
Case
2.
#{149}T#{149}
Electrocardiogram
block
extra
electrocardio-
varying
j$
. .
#{149}#{149}
complexes.
iPIIA
death,
of QRS
__
S
-
before
Among
abnormalities
include
:
:L
systoles.82
PR-interval
5% of
nonspecific
reported
and
:
1-
widening
common
electrocardiois flattening
or inver-
T waves;
findings.9
zi
ksb$
one
day
before
and
A-V
dissociation.
death
showing
left
bundle-branch
deoccur
553
ARTICLES
but
are
unusual
velopment
in
of
heart
block
tality
with
branch
is ominous
these
block
with
disease.3
or
the
is
of the
is also
es
dle-branch
block,
complication
terminally
from
both
rhythm
disturbances
complete
(Figs.
left
bundle-branch
A-V
other
dissociation;
survived
now
attending
school
dissociation,
have
ical
examination
complete
have
more
and
the
only
had
to
or
the
and
It has
graphic
in
changes
and
P
a variety
who
had
findings
as
exact
significance
suggested
of histologic
infectious
evidence
cause
of
of
these
remain
that
un-
although
disease
can
Anteroposterior
and
be
doubted,
their
considerable
that
lead
myocardial
sults
in
This
has
to
congestive
not
that
block
decade
of diphtheritic
against
this,
of
two
SIZ(
the
days
chest
before
piralysis
Ifl(l
interpretation
re-
caution.
It is possible
believe
heart
film
(below)
increased
heart
of left hemi-diaphragm).
may
sixth
or electrocardio-
3.
admission,
(showing
quires
abnormalities
The
Case
on
scarcely
myocarditis;
these
pathological
in
also
4.
( above)
death
lobar
These
changes
diphtheritic
with
FIG.
of
5
fever,17
and
as diphtheria.
their
been
presence
interpret.
ST-segment
and
abnormal
electrocardiographic
myocarditis.
clear.
marked
without
to
in patients
patient
clinical
changes
less
electrocardiographic
succumbed
no
cardio-
including
occurred
however,
phys-
show
as prolongation
reported
typhoid
as well
severe
findings
on
difficult
variations
diseases
variations
block
as well.
more
been
poliomyelitis,16
pneumonia17
these
generally
or QT interval,
abnormalities,
infectious
heart
of transient
abnormalities
is
waves
abblock,
myocarditis
x-ray
nonspecific
PR
pres-
myocarditis.
with
of
chest
of the
T-wave
the
diphtheritic
The
occurrence
electrocardiographic
Such
is
illness;
persists.
and
and
progression
and
his
bundle-branch
patients
on
the
is
diphtheria,
evidence
megaly
had
while
survivor
regularly
as
of
addition,
developed
electrocardiographic
diagnostic
In
who
both
block
such
also
succumbed
patients
following
evident
normalities
A-V
and
two
bundle-branch
are
dissociation,
one child
died
(Figs.
3 & 6). The
marked
shifted
showed
A-V
block,
In clinically
bun-
these
bundle-branch
block)
the
3 years
of
left
( one
Of
asymptomatic
ence
of
ultimately
heart
2 & 5).
left
to
patients
children
right
one
right
block;
one
Two
developed
and
in
Bundle-
a serious
series
mor-
reported
14
present
de-
complete
prognostically;
findings
a similar
in
The
dissociation
54% to 100%
from
this
A-V
been
diphtheritic
myocarditis
fibrosis
failure
later
proven.
which
in life.19
Some
re20
observers
many
which
of the cases
of complete
are first
noted
in the
of life
and
beyond
myocarditis.21
100 patients
who
are
sequelae
As evidence
had suffered
DIPHTHERIA
554
from
severe
were
or moderately
examined
15
to
infection;
none
showed
ventricular
or
intraventricular
increasingly
with
complete
genital
this
not
in
unsatisfactory.
used,
the
been
heart
recovery
from
the
myocarditis
to be good.
era
may
of
the
explain
Though
thus
results
is
Digitalis
is recom-
episode
of
the
diph-
prognosis
the
history
of fever,
measures.
the
admission
1980,
of the
with
neck,
x-rays
increase
film
in
(Fig.
taken
shortly
heart
size
one-day
and
respira-
before
la,
b). Two
as
taken
dissociation
complexes
this
time
6 hours
with
before
marked
death,
widening
death
compared
to
showed
interval,
block;
revealed
of
serum
potassium
Approximately
the
the
A-V
QRS
value
at
24 hours
2 (7-64-86)
J.
mitted
to
6-day
ceived
lings
Latin
American
boy was adthe hospital
December
9, 1960, with a
history of sore throat and fever. He had reno immunizations
and was one of five siba 6-year-old
T.,
simultaneously
hospitalized
with
ures.
interval
admis-
diphtheria.
Physical
examination
revealed
a moderately
ill boy
with findings
of laryngotracheal
diphtheria.
Ampultatjon
of the heart was unremarkable
on admis-
dilitation.
showed
mono-
interstitial
edema, swelling
and loss of cross-striations
at
levels.
3 (8-67-96)
P.,
an
11-year-old
to the
history
Latin
American
hospital
January
8,
of swelling
of the
neck,
boy
1962,
was
with
sore
throat,
Chest
x-ray
on
admission
revealed
elevation
on
QT
revealed
of the myocardium
electrocardio-
study
cell infiltration,
the muscular
fibers,
2-day
swelling
Chest
an
cardiac
examination
Microscopic
R.
tory difficulty.
He had received
no immunizations.
Physical
examination
revealed
an acutely
ill child
with evidence
of laryngotracheal
diphtheria.
Amcultation
of the heart disclosed
no abnormalities
on admission.
Treatment
consisted
of tracheostomy,
intravenous
diphtheria
antitoxin,
penicillin
and
chloramphenicol,
digitalization,
and
supportive
revealed
mortem
Reports
22,
when
weakwhich
The
cardiac
arrhythmia
were
poor and terminally
veloped.
He died on the eighth
Case
Caucasian
at a time
of nausea
and
was
obtained
3)
admitted
a 4-year-old
hospital
August
clinically
diph-
of
1 (7-33-85)
F. W.,
to
tracheostomy,
ness. An electrocardiogram
revealed
that A-V dissociation
branch block had developed
since
different
Case
observed
complaining
was
nuclear
APPENDIX
Case
of
sounds
If
acute
consisted
was
child
(Fig.
steroids
far have
failure
Treatment
arrhythmia
con-
myocarditis
occurs,
theritic
appears
The
infants
that
block
encouraging.
when
atrio-
this
suggests
heart
mended
of
of
in some
adults.
for diphtheritic
generally
have
been
their
block.22
care
complete
theria antitoxin,
penicillin,
and supportive
messures. Chest x-ray on admission
was normal,
while a
Later film showed
cardiac enlargement.
An electrocardiogram
taken
on admission
showed
prolongation of the QT interval
and widespread
flattening
of T waves.
On the seventh
hospital
day, a cardiac
block
baby
finding
Treatment
sion.
after
discovery
heart
well
diphtheria
years
evidence
common
routine
severe
20
normal
sinus
rhythm
with
a prolonged
QT
right
bundle-branch
hospital
day, the right
bundle-branch
tern had shifted
to left bundle-branch
block
pat-
block and
complete
heart block was present
(Fig. 5, below).
At this time
he had developed
nausea,
weakness,
and lethargy.
Physical examination
revealed
bradycardia
with
marked
cardiac
irregularity
and
poor
heart
tones. Steroid therapy
was begun.
Hypotension
and evidence
of a moderate
degree
of congestive
was
heart
initiated.
Postmortem
failure
He
developed
died
examination
on
and
the
revealed
ninth
digitalization
hospital
cardiac
day.
dilata-
and
of
the
555
ARTICLES
vad
--v-
_J_
____ ____
FIG.
5.
Case
3.
Electrocardiogram
tion
of
PR
interval
and
(lay,
days
before
death,
showing
G.C.,
the
history
of
fever
Physical
Latin
hospital
and
examination
penicillin,
and
hospital
ness,
day,
time
revealed
compared
with
oxalacetic
40)
and
ad-
with
compatible
an
were
said
measures.
substernal
irregular
to
significant
his
erythrocyte
evidence
of
antitoxin,
On the second
pain, weak-
be
pulse
fair.
was
film.
78
sedimentation
heart
Chest
increase
admission
with
x-ray
in heart
Serum
units
size
rate
was
at
as
noted
(Fig.
though
tamic
oxaiacetic
mained
elevated
left
charge
on
physical
to
the
subsequently
62
of disblock
findings
within
returned
in
and
fell
normal.
1962,
he
entirely
electrocardiographic
block
at
slightly
was
(Fig.
but
time of
day;
this
When
the
attending
of
6,
dishas
patient
school
asymptomatic,
abnormality
persisted
to
gin-
the
hospital
to
was
were
rate returned
day; his serum
units
thirty-sixth
examined
branch
bundle-
At the time
bundle-branch
transaminase
but
his
left
bundle-
the
were obcardiac
below).
SUMMARY
40
mm/hour.
At this time
his electrocardiogram
revealed normal
sinus
rhythm
with
left bundle-branch
block.
On the
thirteenth
hospital
day,
he had
developed
A-V dissociation
which
persisted
briefly,
and
an occasional
premature
ventricular
contrac-
and
limits.
His sedimentation
by the tenth
hospital
10was
left
6, above).
rhythm
present,
normal
normal
was
prolongahospital
block.
sinus
regularly
glutamic
(normal
were
abnormalities,
heart
charge
duration.
findings
developed
and
transaminase
the
of 8 days
revealed
was
1959,
ST-T
complete
diphtheria
without
consisted
of diphtheria
he
which
boy
11,
throat
supportive
nausea,
sounds
American
August
sore
with nasopharyngeal
carditis.
Treatment
this
and
tion
a 9-year-old
to
hospital
day, showing
(below)
on seventh
and
widespread
block,
4 (6-24-54)
mitted
third
block;
bundle-branch
branch
Case
on
(above)
right
Ninety-eight
cases of diphtheria
served
in a 5% year period,
and
findings
deaths.
were
evaluated.
Three
patients
There
were
were
dead
nine
on
ar-
DIPHTHERIA
556
,jc
.%
L
I__
showing
6.
Case
4. Electrocardiogram
A-V dissociation,
premature
1)ranch
l)lOCk;
FIG.
rival
at
the
evidence
of
of
hospital
and
(below)
and
persistence
(without
myocarditis)
diphtheritic
and
three
three
who
succumbed
had
been
immunized
diphtheria.
Four
patients
developed
against
complications.
electrocardiographic
of myocarditis,
27 children
graphic
nificance.
logical
sence
and
and
showed
clinical
of
patient
evidence
of
had
transient
ographic
abnormalities
block.
significance
remains
questionable
myocarditis
child
are
showing
normal
trocardiographic
sigthe
ab-
heart
in
rhythm
unclear.
Marked
block
patients
A-V
are
with
elec-
such
as bun-
dissociation,
diagnostic
and
of myo-
diphtheria.
1. Keith,
J. D., Rowe, R. D., and Viad, P. : Heart
Disease
in Infancy
and
Childhood.
New
York, Macmillan,
1958, p. 704.
2. Doege,
T. C., Heath,
C. \V., Jr., and Sherman,
I. L. : Diphtheria
in the United
States,
19591960.
3. Friedberg,
electrocardifrequent,
day
bundle-
REFERENCES
or pathoin
sinus
block,
complete
left
abnormalities
dle-branch
carditis
abnormalities.
nonspecific
left
evidence
clinical
of electrocardiographic
Although
bundle-branch
three
died.
In addition,
minor
electrocardio-
abnormalities
No
No
hospital
and
later
as
of respiratory
thirteenth
contraction,
years
died
result
on
of
postmortem
while
myocarditis
(above)
ventricular
2.
their
PEDIATRICS,
30: 194,
C. K. : Diseases
Philadelphia
and London,
1962.
of
the
Heart,
Saunders,
p. 906.
Ed.
1956,
557
ARTICLES
4.
C. :
Wesselhoeft,
diphtheria.
Cardiovascular
New
Engi.
disease
J.
Myocardial
changes
in fatal
diphtheria.
Amer.
J. Med. Sci., 215:257, 1948.
6. Hoyne,
A., and Welford,
N. T. : Diphtheritic
myocarditis,
a review
of 496 cases.
J. Pediat.,
5:642,
1934.
7. Ball, D. : Diphtheritic
myocarditis.
Amer. Heart
J., 29:704,
1945.
8.
I.:
Begg,
N.
D. :
Diphtheritic
myocarditis:
electrocardiographic
study.
857, 1937.
9. Burkhardt,
E. A., Eggleston,
L.
W. : Electrocardiographic
peripheral
Amer.
10.
Altshuler,
an
Lancet,
C.,
232:
and
Smith,
changes
and
S.,
Hoffman,
K.
M.,
and
gerald,
P. J. : Electrocardiographic
in diphtheria.
Ann.
Intern.
Med.,
Fitz-
changes
29:294,
15.
of
bundle
Heart
12.
13.
H.:
Cookson,
Heart
block
branch
block
J., 7:63,
the simulation
in diphtheria.
Brit.
and
16.
Neubauer,
and
Auricular
M.,
L.:
Electrocardiographic
Weinstein,
fibrillation
studies
Med.
Boyer,
from complete
Pxawrsucs,
N.
H.,
and
J. Pediat.,
Shelokov,
L.,
and
manifestations
Engi. J. Med.,
during
46:30,
A. :
the
1955.
Cardiovas-
cause
22.
acute
1958.
N. : Progressive
myocardial
damrecovery
from
diphtheria.
Amer.
J. Cardiol.,
9:790,
1982.
Butler,
S., and
Levine,
S. A.: Diphtheria
as a
Claman,
age
21.
in
heart
3:222,
Weinstein,
changes
of measles.
48:146,
20.
Thompson,
P. D.:
severe
auricu-
J., 7:59,
Heart
poliomyelitis.
244:281,
1951.
17. Fine,
I., Brainerd
H., and Sokolow,
N.: Myocarditis
in acute
infectious
diseases.
Circulation,
2:859,
1950.
18. Nadas,
A. S.: Pediatric
Cardiology,
Philadelphia and London,
Saunders,
1957, p. 228.
19. Sayers,
E. G. : Diphtheritic
myocarditis
with
permanent
heart damage.
Ann. Intern.
Med.,
5:592,
Acta
C.:
1949.
Goldfleld,
cular
New
1945.
Andersen,
M. S.: Electrocardiographic
on diphtheritic
myocarditis.
Scand., 84:268,
1934.
Brit.
Engle,
M. A.: Recovery
block
in diphtheria.
course
1948.
11.
in diphtheria.
1945.
14.
1940.
5. Gore,
lar flutter
in
223:57,
Med.,
H.
following
of late
heart
block.
Amer.
Heart
J.,
1930.
W.
P.,
The heart
diphtheria.
Golden,
fifteen
Amer.
S. E.,
to twenty
Heart
and White,
years after
J.,
13:534,
1937.
Citations
Reprints
PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly publication, it
has been published continuously since 1948. PEDIATRICS is owned, published, and trademarked by the
American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village, Illinois, 60007.
Copyright 1963 by the American Academy of Pediatrics. All rights reserved. Print ISSN: 0031-4005.
Online ISSN: 1098-4275.