Fulminant myocarditis in a patient with severe coronary artery disease

Abstract

A 55-year-old man complaining of fever and exertional dyspnea was admitted for coronary angiography to differentiate between fulminant myocarditis and acute coronary syndrome. He had been treated for 17 years for angina pectoris. His electrocardiogram demonstrated ST segment changes in almost all leads. Cardiac catheterization demonstrated severe stenosis in the left descending artery, the diagonal branch, and the right coronary artery. Ultrasonography, however, revealed diffuse hypokinesis of the left ventricle and edematous wall thickening, suggesting fulminant myocarditis. This is the first report in which a patient with fulminant myocarditis with severe coronary artery disease was successfully treated with mechanical cardiopulmonary support, intensive pharmacological therapy, and staged coronary intervention procedures. Complicated coronary artery disease may delay the diagnosis of myocarditis and worsen the clinical outcome. Patients having fulminant myocarditis with coronary artery disease need careful diagnosis, and percutaneous cardiopulmonary support should be considered in the early clinical stage.<Learning objective: Complicated coronary artery disease may delay the diagnosis of myocarditis and worsen the clinical outcome. It is considered safe to use percutaneous cardiopulmonary support for such patients in the early clinical stage. The present case was rescued with mechanical support in the acute phase of fulminant myocarditis and elective coronary angioplasty in the recovery phase.>