SESSION TITLE: Cardiovascular Student/Resident Case Report Posters II
SESSION TYPE: Medical Student/Resident Case Report
PRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PM
INTRODUCTION: The published literature on recurrent acute myocarditis in healthy young persons is limited, especially when it comes to management and what to expect from the patient. We are reporting a case of an otherwise healthy young woman, who presented with acute myocarditis and a year later she came back with a recurrent episode, with preserved left ventricular (LV) function on both occasions.
CASE PRESENTATION: 27 year-old female presented with severe, retro-sternal chest pain, radiating to the neck. The pain started one hour before presentation while at rest and lasted four hours. She reported nausea and mild shortness of breath associated with the pain. The patient was an active smoker but denied alcohol or drug use. She had no drug allergies or significant past medical history. She endorsed having flu-like symptoms three weeks before presentation. One year earlier she had presented with similar complaint several weeks after having flu-like symptoms. The blood work was significant for cardiac troponin I of 28 ng/ml and elevated titers for Coxsackie B1 virus; electrocardiogram (ECG) and echocardiogram were normal. On this presentation blood pressure was 110/62 mmHg, heart rate 71 beats/minute, respirations 18/minute and temperature 98.5° F; Physical exam was unrevealing. Blood work was normal, except for elevated cardiac Troponin I of 18.3ng/ml and CK-MB of 50 ng/ml; urine toxicology was negative. An ECG showed low voltage in precordial leads, otherwise was normal. An echocardiogram evidenced normal ejection fraction. A cardiac MRI reported several foci of delayed enhancement in the mid myocardium and sub-epicardium in a nonvascular distribution, consistent with myocarditis. During both presentations the patient was managed with supportive therapy, with complete resolution of symptoms.
DISCUSSION: Myocarditis can course as a myocardial infarct-like syndrome with preserved LV function. However, recurrence of such an episode in a young healthy person is uncommon. In terms of diagnosis, the history plays an important role, along with the ECG, echocardiogram and cardiac markers. Moreover, CMR is highly specific for the diagnosis of myocarditis. Endomyocardial biopsy is recommended when the prognostic and therapeutic information outweighs the risks and costs of the procedure [1,2].
CONCLUSIONS: Recurrent myocarditis is an uncommon condition. Management of each episode is guided by the clinical scenario presented and the complications that arise. Close observation is important, in case that clinical signs of heart failure or arrhythmias arise.
Reference #1: Sandeep Sagar, Peter P Liu, Leslie T cooper Jr. Myocarditis. Lancet 2012; 379: 743
Reference #2: Cooper LT, Baughman KL, Feldman AM, et al: The role of endomyocardial biopsy in the management of cardiovascular disease: A scientific statement from the American Heart Association, the American College of Cardiology, and the European Society of Cardiology. Circulation 116:2216, 2007.
DISCLOSURE: The following authors have nothing to disclose: Geurys Rojas-Marte, On Chen, Sameer Chadha, Anand Rai, Vijay Shetty, Jacob Shani
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