Clinical case of acute myocarditis with outcome in dilated cardiomyopathy

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Abstract

A clinical case of acute myocarditis in a 55-year-old military man with an outcome of dilated cardiomyopathy is presented. During the examination, magnetic resonance imaging with a paramagnetic contrast agent was performed – the main instrumental diagnostic method, which is the most informative for visualizing foci of inflammation, damage and necrosis of cardiomyocytes. Intravital diagnosis of myocarditis was carried out through histological confirmation of the diagnosis by performing endomyocardial biopsy. During the examination, coronary heart disease and amyloid cardiomyopathy were excluded. The patient was selected for anti-inflammatory, antiarrhythmic therapy, and was prescribed treatment for heart failure with low ejection fraction (quadruple therapy, including an angiotensin receptor and neprilysin inhibitor, beta blocker, mineralocorticoid antagonist, sodium-glucose co-transporter type 2 inhibitor). The patient experienced significant positive changes, such as improved tolerance to physical activity, reduction in lower extremity edema, and decreased shortness of breath during walking.

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About the authors

A. N. Kuchmin

The S.M.Kirov Military Medical Academy of the Ministry of Defense of the Russian Federation

Author for correspondence.
Email: vmeda-na@mil.ru

профессор, полковник медицинской службы запаса 

Russian Federation, St. Petersburg

M. V. Rudakova

The S.M.Kirov Military Medical Academy of the Ministry of Defense of the Russian Federation

Email: vmeda-na@mil.ru
Russian Federation, St. Petersburg

A. V. Tanich

The S.M.Kirov Military Medical Academy of the Ministry of Defense of the Russian Federation

Email: vmeda-na@mil.ru
Russian Federation, St. Petersburg

D. A. Galaktionov

The S.M.Kirov Military Medical Academy of the Ministry of Defense of the Russian Federation

Email: vmeda-na@mil.ru

кандидат медицинских наук, подполковник медицинской службы

Russian Federation, St. Petersburg

E. R. Shikhmurzaeva

The S.M.Kirov Military Medical Academy of the Ministry of Defense of the Russian Federation

Email: vmeda-na@mil.ru
Russian Federation, St. Petersburg

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2. Fig. 1. ECG of patient C. at the time of admission: atrial fibrillation with ventricular contraction rate of 110 per minute. Horizontal position of the electrical axis of the heart, blockade of the anterior branch of the left bundle branch of Hiss with focal intraventricular blockade. Signs of left ventricular hypertrophy

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3. Fig. 2. Cardiac MRI with gadolinium in patient C. Change in the intensity of gadolinium accumulation in the LV wall is noted. The figure is marked with an arrow

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4. Fig. 3. Cardiac MRI with gadolinium in patient C. Thrombus in the LV cavity. Marked with an arrow

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5. Fig. 4. ECG of patient C. Tachysystolic form of atrial fibrillation with a ventricular contraction rate of 111 per minute. Sharp deviation of the electrical axis of the heart to the left. Blockade of the anterior branch of the left leg of the Gis bundle. Signs of LV hypertrophy. Compared to the previous ECG, pronounced repolarization changes in the apex, lateral wall of LV without convincing dynamics

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6. Fig. 5. EchoCG of patient C. The arrow indicates a thrombus in the LV cavity. Dilatation of all heart chambers, eccentric LV hypertrophy can also be noted

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7. Fig. 6. EchoCG of patient C. Bull's eye technique. Diffuse disturbances of longitudinal myocardial deformation are revealed

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8. Fig. 7. Microscopic preparations of myocardium of patient C. Hematoxylin-eosin staining. On the left - infiltration with leukocytes. On the right - nuclear polymorphism is visualized; focal hypertrophy, interstitial edema; full blood clotting of single capillaries

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9. Fig. 8. Echo CG of patient C. Longitudinal deformation of LV myocardium before treatment (left) and against the background of therapy (right)

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Copyright (c) 2024 Kuchmin A.N., Rudakova M.V., Tanich A.V., Galaktionov D.A., Shikhmurzaeva E.R.


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