An unusual case of fulminant myocarditis closely mimicking ST-segment elevation myocardial infarction and presenting as refractory cardiogenic shock complicated by multiple life-threatening arrhythmias

• Published in: Revista portuguesa de cardiologia 2015-12, Vol.34 (12), p.771.e1-771.e5
• Main Authors: Wang, Zhi-quan, Li, Yi-Gang
• Format: Article
• Language: English
• Subjects: Balão intra-aórtico; Cardiac pacemaker; Cardiogenic shock; Choque cardiogénico; Fulminant myocarditis; Humans; Intra-aortic balloon pump; Intra-Aortic Balloon Pumping; Miocardite fulminante; Myocardial Infarction; Myocarditis - diagnosis; Pacemaker cardíaco; Shock, Cardiogenic; ST Elevation Myocardial Infarction - diagnosis
• ISSN: 0870-2551; 2174-2030
• DOI: 10.1016/j.repc.2015.03.030

We report a case of severe fulminant myocarditis that closely mimicked acute inferior ST-segment elevation myocardial infarction (STEMI) and presented with refractory cardiogenic shock, multiple life-threatening arrhythmias and rapidly progressive liver failure. This case was successfully differentiated from STEMI by emergency coronary angiography. Recurrent cardiogenic shock was reversed by intra-aortic balloon pumping (IABP). Life-threatening arrhythmias including ventricular tachycardia, ventricular fibrillation, and high-degree atrioventricular block (AVB) were terminated by immediate cardioversion and temporary pacemaker. High-dose hydrocortisone effectively attenuated the inflammatory injury to the myocardium. The patient recovered and was well at the follow-up visit four months after discharge. Relatamos um caso real de miocardite fulminante grave simulando enfarte agudo do miocárdio agudo inferior com supra desnivelamento ST (STEMI) com choque cardiogénico refratário, arritmias fatais múltiplas e lesão hepática funcional progressiva. Detetou-se com eficácia que não se tratava de STEMI através de angiografia coronária de urgência. O choque cardiogénico recorrente foi resolvido com eficiência através de balão intra-aórtico. Arritmias fatais incluindo a taquicardia ventricular, a fibrilhação ventricular e o bloqueio auriculoventricular de alto grau foram ultrapassadas por cardioversão imediata e pacemaker temporário. Uma dose elevada de hidrocortisona atenuou eficazmente lesões inflamatórias no miocárdio. O doente ultrapassou esta situação e estava totalmente recuperado na consulta de follow-up quatro meses após a alta.