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Ivcd cardiac murmurs1/27/2024 Lab data showed troponin: 1.8 ng/dL, NT-proBNP: 18000 pg/mL and normal electrolyte range.Įchocardiography revealed severe biventricular dysfunction, LVEF: 10% - 15% moderate MR, mild PE. She was afebrile but she had diaphoresis, cold sweating and weak arterial pulse.ĮCG revealed complete heart block (CHB) and intra-ventricular conduction delay (IVCD) ( Figure 2B). Heart rate was 45 beat/min and blood pressure was 85/50 mmHg. She was in respiratory distress and complete atrio-ventricular block. Case IIĪ 45-year-old woman admitted with syncope, chest pain and dyspnea to Rajaie Heart Center. Arrhythmia and hospitalization decreased after 12 months of therapy.Ī, Ventricular tachycardia probably with mitral ring origin B, sinus rhythm with ST-T change C, histopathological view of myocardial sample revealed giant cell and inflammation D, cardiac MR with diffuse myocardial edema in the short inversion time inversion recovery (STIR) technique 2.2. With due attention to frequent ventricular arrhythmia, the patient underwent VT ablation and insertion of implantable cardioverter defibrillator (ICD).ĭespite the treatment of arrhythmia, it continued and as a result the patient was treated initially by methyl prednisolone infusion (500 mg) a day in three doses then continuing with 15 mg oral prednisolone and mycophenolate mofetil (MMF) (1 g daily) in addition to metoprolol succinate, spironolactone, lisinopril and amiodarone. Therefore, EMB was done and showed mild infiltration of lymphocytes, macrophage and multinucleated giant cell ( Figure 1D). Cardiac magnetic resonance (CMR) imaging showed acute extensive myocarditis with left ventricular involvement of anterolateral, inferolateral and apical segment ( Figure 1C). Ventricular arrhythmia frequently happened, so coronary angiography was done and the results were normal. Echocardiography revealed moderate to severe global left ventricular (LV) dysfunction with estimated ejection fraction (EF): 30% - 35%, mild mitral regurgitation (MR), severe apical and posterior hypokinesia and mild pericardial effusion (PE). Lab data showed ESR: 34 mm/h, anti-CCP (cyclic citrullinated peptide): 9 U/mL, troponin :0.53 ng/mL, other lab data, chest x-ray and abdominal sonography was normal. The general physical exam was normal cardiovascular examination after arrhythmia conversion had S4 and mid systolic murmur grade II/VI. ECG of sinus rhythm revealed ST-T change in anterolateral leads ( Figure 1B). The first patient’s electrocardiogram (ECG) showed ventricular arrhythmia with a heart rate of 150 and blood pressure 85/50 then it was converted to sinus rhythm by synchronized DC shock ( Figure 1A). She also did not mention the past history of any extracardiac diseases, drug use and abuse, family history for sudden cardiac death (SCD) and cardiomyopathy. She had no fever, history of flu-like illnesses, malaise, chills, chest pain and dyspnea. She had a history of syncope one day earlier. These cases have been reported for the first time in Iran.Īll patients have consented to publication of information about them contained in case reports.Ī 31-year-old female presented to the medical center with palpitation followed by physical activity. Even with optimal medical care, GCM typically has a bad prognosis ( 3). The basis of its diagnosis is endomyocardial biopsy (EMB) ( 2). GCM presentation of GCM is wide spectrum such as acute coronary syndrome with nonobstructive coronary arteries, acute and subacute heart failure, ventricular arrhythmia and high grade atrio-ventricular block ( 1). Giant cell myocarditis (GCM) is a rare, progressive and fatal myocardial disease. Giant Cell Myocarditis Arrhythmia Immunosuppressant 1. Arrhythmia and symptoms of heart failure with immunosuppression had a relative improvement in three patients.
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