Fulminant but Not Fatal

Abstract

PRESENTATION Myocarditis is an inflammatory disease of the myocardium that can present in myriad ways, ranging from an insidious course to a fulminant form resulting in cardiogenic shock. The diagnosis of this disease is challenging and relies heavily on clinical suspicion, as diagnostic studies have relatively low sensitivity and specificity. A 23-year-old Caucasian woman with no past medical history first noted palpitations during chemistry class. The following morning she felt substernal pressure. Later that day she developed pleuritic chest pain and had several episodes of nonbloody, nonbilious emesis. She also began to experience dyspnea with minimal activity and bilateral lower extremity swelling; therefore, she presented to the Emergency Department. She denied paroxysmal nocturnal dyspnea, orthopnea, lightheadedness, or dizziness. The patient was a social drinker and an occasional marijuana smoker. She had no history of pregnancy, sexually transmitted infections, and was monogamous with one male partner. She had vacationed in Mexico 1 month previously and had hiked in Northern California 5 days prior to presentation. Her family medical history was unremarkable. A review of systems was negative for arthralgias, syncope, cough, rash, or photosensitivity.