Fulminant Myocarditis

“Sick patients die” is a refrain familiar to all clinicians. It can easily be applied to patients with severe congestive heart failure or cardiogenic shock resulting from an acute inflammatory process involving the myocardium. In this issue of the Journal, McCarthy et al.¹ suggest that the opposite may be true: the sickest patients (those with fulminant myocarditis), who constitute a clearly defined, small subgroup, are the most likely to make a full recovery. Such patients have a distinct onset of symptoms, with signs of cardiogenic shock or severe left ventricular dysfunction; they have multiple foci of active myocarditis, as shown . . .