Best Cases: Non-Ischemic Heart Disease-Giant Cell Myocarditis

Video Transcription

Video Summary

A 72-year-old woman with limited systemic sclerosis and pulmonary hypertension developed refractory ventricular tachycardia, cardiogenic shock, and cardiac arrest requiring VA ECMO. Coronary angiography showed minimal CAD, and CMR revealed widespread subepicardial and mid-myocardial late gadolinium enhancement with corresponding wall motion abnormalities. Endomyocardial biopsy from the RV septum showed T-cell inflammation and multinucleated giant cells, confirming giant cell myocarditis. She was treated with IV steroids and cyclosporine, improved temporarily, but later died from recurrent VT and cardiac arrest. Key points: obtain early CMR, recognize the characteristic diffuse LGE pattern, and use it to guide biopsy.

Keywords

giant cell myocarditis

ventricular tachycardia

cardiogenic shock

cardiac magnetic resonance

late gadolinium enhancement