A 55-year-old woman complained of fever, weakness, and generalized malaise. Twelve hours after admission, she had hypotension, atrial fibrillation, and worsening respiratory distress; 24 hours after, she had a cardiac arrest. This echocardiogram showed inferior wall hypokinesis, along with a ventricular septal defect in the inferoseptum, a complication of myocarditis.
Myocarditis, with focal or diffuse inflammation, may be of infectious or noninfectious origin. Viral infections are the most common infectious causes, although the true incidence of viral myocarditis is unknown. Other causes of myocarditis include autoimmune diseases and a hypersensitivity response to drugs.
The clinical presentation of myocarditis varies, ranging from asymptomatic to a fulminant picture, which may include heart failure, arrhythmias, and cardiogenic shock.
Definitive diagnosis requires an endomyocardial biopsy, which should be performed when fulminant or giant cell myocarditis is suspected.
Case and photos provided by Orlando Santana, MD and Michael Funk, MD