ISOLATED RIGHT VENTRICULAR FAILURE REQUIRING MECHANICAL CIRCULATORY SUPPORT AS A PRESENTING MANIFESTATION OF RECURRENT VIRAL MYOCARDITIS

Document Type

Conference Proceeding

Publication Date

4-1-2024

Publication Title

J Am Coll Cardiol

Abstract

Background Myocarditis can manifests in various forms, ranging from asymptomatic to cardiogenic shock (CGS). It is often triggered by viral infections, such as adenovirus. The Human Coxsackievirus and Adenovirus receptor (hCAR), which is localized to the intercalated discs, plays a significant role in the pathogenesis of recurrent viral myocarditis. Case A 20 year old female with a history of Coxsackie B myocarditis presented with CGS following several days of fever and sore throat. She was tachycardic, and hypotensive, requiring vasopressors. Laboratory results indicated lactic acidosis, elevated BNP and high sensitivity troponin, AKI, shock liver, and a respiratory panel positive for adenovirus. An EKG with ST depression in the precordial leads. An echocardiogram revealed a preserved EF of 55-60%, normal left ventricular function, an enlarged severely hypokinetic right ventricle (RV), and a flattened interventricular septum, consistent with acute RV failure. Despite initial resuscitation and inotropic support, she remained in refractory CGS, necessitating the placement of a RV assist device (RVAD). Her symptoms were attributed to a disseminated adenovirus infection, and was started on Cidofovir therapy. She later rapidly improved, and RVAD support was subsequently weaned. Endomyocardial biopsy (EMB) and cardiac MRI (cMRI) performed later during her stay were negative, indicating a positive response to therapy. Decision-making Our patient's case was likely related to the expression of hCAR, explaining her susceptibility to these viruses and the subsequent development of recurrent myocarditis and RV failure. EMB is the gold standard for diagnosis; however, its value can be limited due to presence of areas spared from pathology. cMRI is an alternative diagnostic tool; however, findings can be nonspecific. Conclusion We emphasize the significance of identifying isolated RV failure as a rare yet possible manifestation of myocarditis, particularly in cases of recurrent viral infections. Furthermore, it's crucial to consider an underlying heritable cardiomyopathy, like arrhythmogenic cardiomyopathy in such cases, and discuss the potential need for genetic testing.

Volume

83

Issue

13

First Page

3993

Find It @ Sladen

Share

COinS