Myocarditis is associated with a wide range of infections, most commonly viral (cytomegalovirus), bacterial, and parasitic (Trypanosoma cruzi). Epstein-Barr virus (EBV) rarely causes myocarditis, which is a lifethreatening complication. Autoantibodies against cardiac myocytes activate the complement system and cause diffuse myocyte necrosis. Myocarditis has a variable presentation from asymptomatic to cardiogenic shock. Over time, untreated myocarditis can progress and result in dilated ventricles. Continued dilation of ventricles leads to systolic dysfunction, conduction abnormalities, ventricular arrhythmia, heart failure, valvular abnormalities, and thromboembolism. So, we are emphasizing the importance of early diagnosis and treatment of EBV to prevent mortality. This case study represents a rare case of mortality secondary to EBV infection with resultant DCM and congestive heart failure (CHF).

Licorice has been around for centuries and has been commercialized in the food, tobacco, and healthcare industry. Historically, its therapeutic benefits have been reaped in countless ways, including as a thirst sensation suppressor in battlefields, flavoring agent in medicinal preparations, antacid for gastric discomfort and peptic ulcers, and even as an estrogenic agent in postmenopausal women. Licorice and its derivatives are recognized safe by the US Food and Drug Administration (FDA). Though FDA recognized the licorice to be a food additive in certain concentrations, it has issued warnings against its use in at-risk group and in larger amount. However, it is a lesser known fact that glycyrrhizic acid, the active component in licorice, can cause a metabolic syndrome presenting as pseudohyperaldosteronism. Chronic consumption leads to the development of hypertension, metabolic alkalosis, and hypokalemia. We present a patient who developed a sinus pause on telemetry and subsequent syncope after presenting for evaluation of hypertension and hypokalemia. The patient had been ingesting a significant quantity of deglycyrrhizinated licorice for many years to alleviate postprandial epigastric pain. Although seemingly benign electrolyte disturbance, it is crucial to recognize that chronic consumption of licorice without strict regulation can lead to supraventricular and ventricular ectopics and tachyarrhythmias with the potential to develop lifethreatening arrhythmias including ventricular tachycardia, ventricular fibrillation, and Torsades de Pointes.

SARS-CoV-2, also known as COVID-19, was first identified in Wuhan, China. Symptoms of COVID-19 are fevers, dry cough and less commonly gastrointestinal (GI) symptoms such as diarrhea that occur in 2 to 14 days of exposure. Infection with COVID-19 leads to hospitalizations due to respiratory compromise. Secondary manifestations of this virus should warrant further investigation since little is known about COVID-19 and its role in the cardiac circuit. We present a patient with COVID-19 who developed transient third-degree AV block initially hospitalized for septic shock. The patient presented with mild symptoms and the transient nature of the complete heart block could be a matter of low viral load in his circulation. He recovered from COVID-19 with no long-term cardiac sequelae. The long-term effects of COVID-19 are still unknown; this case presents the cardiac manifestations of the virus.

Drug-drug interactions in medications metabolized by cytochrome P450 enzymes can lead to multi-organ complications. An uncommon but serious potential adverse effect of statins is rhabdomyolysis, most commonly triggered by drug interactions. Rhabdomyolysis presents with markedly elevated creatine kinase levels, dark urine, and often myoglobinuria. The breakdown of the muscles during rhabdomyolysis can be toxic to the kidneys, often precipitating acute kidney injury (AKI) and can also damage the liver, causing transaminitis. This study presents a case of a 66-year-old male with delayed onset complex pharmacological interaction between ticagrelor, rosuvastatin, and amiodarone resulting in rhabdomyolysis, AKI, and transaminitis.

There are few major adverse events after the coronavirus disease 2019 (COVID-19) vaccination. However, increasing cases of myocarditis and pericarditis are being reported to the Vaccine Adverse Event Reporting System (VAERS) in young people, primarily after the second dose of messenger RNA (mRNA) COVID-19 vaccines. We present a case series of myopericarditis post mRNA (Moderna) and myocarditis post vectorbased (Johnson & Johnson) COVID-19 vaccines. We intend to highlight the importance of early diagnosis and treatment of vaccine-related myocarditis to reduce mortality and morbidity.