Myocarditis, Acute

Sudden 2

Step 1: View clinicals

A 20 year old woman presents with worsening exertional dyspnea for 2 days. She developed a fever 7 days ago, which was associated with coryza and rhinorrhea, and which subsided after 4 days. Her medical history is otherwise unremarkable.


Step 2: Order all relevant investigations

Full Blood Count

WBC/DC: 6,000/mm3 Neutrophils: 50% Lymphocytes: 50% Hb: 12.2 g/dL Hct (PCV): 35% Platelets: 228,000/mm3

ECG

There are T inversions in all leads. Serial ECGs show no dynamic changes.

Echocardiogram

There is global hypokinesis and mild dilation of both ventricles, with a jerky myocardium. There are multiple regional wall motion abnormalities and the ejection fraction is 40%.

Endomyocardial biopsy

The endomyocardial biopsy shows a lymphocytic inflammatory infiltrate with evidence of myocyte necrosis.


Step 3: Select appropriate management

Calcium channel blockers
Diuretics
IV Antibiotics stat
Corticosteroids


Score: ★★☆