31st European Heart and Heart Failure Congress
Title: Myocarditis induced ventricular tachycardia
Biography: Nang Khaing Zar
Background: Myocarditis is an acute infectious or immunologically mediated syndrome causing inflammation of the heart muscle. Around half of all cases are idiopathic (Karjalainen et al. 1983). Possible complications include syncope, arrhythmia and heart failure.
Presentation: 65 year old man with background hyperlipidaemia was presented with chest pain and palpitation. Initial ECG was monomorphic VT. Patient was haemodynamically stable. Subsequently, VT was approaching 240 bpm. Decision was made to proceed with cardioversion and sinus rhythm was restored. Electrolyte disturbance was excluded and angiogram was performed which did not show any flow limiting coronary artery disease. Cardiac MR had demonstrated normal left ventricular function with patchy mid wall epicardial mid gadolinium enhancement, consistent with a diagnosis of likely myocarditis although nonspecific cardiomyopathy could not be excluded. Being SVT with aberrancy a differential in view of regular broad complex tachycardia, EP study was subsequently performed and had confirmed VT. The patient then underwent ICD implantation and discharged well.
ECG: to be displayed on poster
Discussion: The mechanisms for ventricular arrhythmias during myocardial inflammation are unknown. Endomyocardial biopsy is not necessary for the diagnosis of myocarditis. MRI should be performed in patients resuscitated from sudden cardiac death, to rule out myocardial inflammation. Although it is difficult to establish the exact prognosis, it is suggested that the prognosis of patients with resuscitated sudden cardiac death in the onset of acute myocarditis is favourable, arrhythmias usually being self-limited with no recurrences that follow the acute phase.
E-journal of the ESC Council for Cardiology Practice. 05/04/2011. Ventricular arrhythmias complicating acute myocarditis
Celia Bagshaw / Editors: Jason Kendall, Stewart H McMorran. 08/11/2017. Myocarditis. RCEM learning.
Khabbaz Z, Grinda JM, Fabiani JN. Extracorporeal life support: an effective and non-invasive way to treat acute necrotizing eosinophilic myocarditis. J Thorac Cardiovasc Surg. 2007; 133(4): 1122-3.
Chau EM, Chow WH, Chiu C, Wang E. Treatment and outcome in biopsy proven fulminant myocarditis in adults. Int J Cardiol. 2006; 110 (3): 405-6.