Myocarditis and Sudden Cardiac Death in the Young

Abstract

A 15-year-old male presented clinically with myocarditis. At follow-up, a 12-lead ECG (Figure 1A) and chest x-ray were performed (Figure 1B). Echocardiography was reported to show at least mildly impaired left ventricular function, and cardiovascular magnetic resonance (CMR) demonstrated a severely dilated impaired left ventricle (end-diastolic volume index, 160 mL/m2; ejection fraction, 42%), normal proximal coronary arteries, and a pattern of late gadolinium enhancement (LGE) which indicated extensive myocardial scarring as a result of myocarditis (Figure 2). The patient remained asymptomatic. Unfortunately, he died suddenly 2 years later. The post mortem distribution of scarring was concordant with the in vivo CMR LGE findings. Figure 1. A, 12 lead ECG demonstrates sinus arrhythmia with a single junctional beat and normal axis. Peaked T waves of uncertain significance are noted. B, Chest x-ray showed a cardiothoracic ratio of 0.47. Figure 2. The 12-panel figure shows echocardiographic images in the left column (from top to bottom) in parasternal long-axis, basal short-axis, mid short-axis, and apical short-axis orientations. Cine CMR images in corresponding planes are shown in the middle column with late gadolinium imaging in the right column. Of note, the cine CMR images clearly show thinning …