Fulminant myocarditis

Description

A previously healthy 36-year-old man presented to the emergency department with dyspnoea after 3 days of fatigue and coughing. He experienced shortness of breath and had 8 hours of fever before admission. His body temperature was 38°C. His ECG showed a wide QRS complex with no signs of acute myocardial infarction (figure 1). Echocardiography demonstrated oedematous left ventricular myocardium and severe, diffusely hypokinetic left ventricular wall motion with estimated ejection fraction of 30%. Intra-aortic balloon pump (IABP) insertion was immediately performed for cardiogenic shock. Meanwhile, he experienced cardiac arrest with ventricular tachycardia. As cardioversion was unsuccessful, peripheral venous-arterial extracorporeal membrane oxygenation (va-ECMO) was initiated, with temporary pacemaker placement and dobutamine administration. Coronary angiography revealed normal coronary arteries. Shortly thereafter, he developed complete ventricular standstill, with no ventricular activity on the ECG and echocardiogram (figure 2 and video 1). Endomyocardial biopsy revealed massive...

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