SHM Converge Scientific Abstract ePoster Gallery-A Fight With Fulminant Myocarditis: A Case of Sudden Cardiac Compromise in a Young Patient

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This case describes a 39-year-old woman who presented with several days of nausea, vomiting, fatigue, and lightheadedness. Although her initial exam was largely normal, laboratory studies showed elevated troponin T, NT-proBNP, and C-reactive protein, and urine toxicology was positive for amphetamines. Her ECG initially showed sinus tachycardia with right bundle-branch block, but she later developed high-degree AV block requiring emergent transvenous pacing.<br /><br />Further evaluation suggested myocarditis. Transthoracic echocardiography showed preserved to mildly reduced left ventricular function (LVEF 50–55%), increased wall thickness, and a small pericardial effusion. Coronary angiography revealed normal coronary arteries with basal inferior wall hypokinesis, helping exclude ischemic disease. Cardiac MRI demonstrated mild subepicardial delayed enhancement in the lateral wall, consistent with myocarditis. Endomyocardial biopsy confirmed lymphocytic myocarditis without viral cytopathic effect. An extensive infectious and autoimmune workup was negative.<br /><br />Despite supportive care, the patient deteriorated and required an intra-aortic balloon pump and milrinone for hemodynamic support. She was treated with intravenous steroids and gradually improved, ultimately being discharged on a prednisone taper with improved LVEF (60–65%) and counseling for substance abuse.<br /><br />The report emphasizes that fulminant myocarditis is a rare but life-threatening condition that can rapidly progress to cardiogenic shock and arrhythmias. Diagnosis depends on combining clinical findings, imaging—especially cardiac MRI—and histopathology, with endomyocardial biopsy remaining the gold standard. Early recognition and intensive management, including mechanical support and immunosuppression when appropriate, are critical for survival.

Asset Subtitle

Ranjit Sapkota

Meta Tag

Author List Daniel Tambunan, Ranjit Sapkota, Shristi Nepal, Tareq Alsaleh

Category Clinical Vignettes

Concept Fulminant Myocarditis

Concept Cardiac Biopsy

Concept Myocarditis

Concept Cardiogenic Shock

Concept Magnetic Resonance Imaging

Distinguished Non-Finalist

Presenter Organization AdventHealth Orlando, Florida

Presenting Author Ranjit Sapkota

Track Adult

Keywords

fulminant myocarditis

lymphocytic myocarditis

amphetamine use

high-degree AV block

cardiogenic shock

cardiac MRI

endomyocardial biopsy

troponin elevation

intra-aortic balloon pump

prednisone taper

Fulminant Myocarditis

Cardiac Biopsy

Myocarditis

Cardiogenic Shock

Magnetic Resonance Imaging