A case report of myocarditis and sinus arrest

Abstract

IntroductionMyocarditis is a focal or diffuse inflammatory disease of the myocardium [1] . Prevalence of arrhythmia associated with myocarditis has been reported as merely 18%. These arrhythmias include new-onset atrial or ventricular arrhythmias or high-grade Atrioventricular (AV) block while some of these arrhythmias may be life-threatening [2] . Several cases of AV block during myocarditis course have been reported [3,4] . Sinus arrhythmias in myocarditis are uncommon. Only one case of recurrent sinus arrest lasting for 8 seconds in a patient with Lyme carditis had been reported [5] . Here, we report a case of acute myocarditis presenting with syncope related with recurrent sinus arrest. Case ReportA 33-years-old female patient was referred to our clinic for further investigation of her syncope. The patient described fever and flu-like symptoms for the last 3 days. Her physical examination was normal, with blood pressure 120/80 mmHg, heart rate 52 bpm and body temperature 37.1°C. Chest-X ray was normal. Electrocardiogram (ECG) revealed abnormal intraventricular conduction, first degree AV block and inverted T waves in leads I, II, III, a VF and V3-6 ( Figure 1A). Echocardiographic examination showed normal left ventricular systolic function with ejection fraction 60% and mild pericardial effusion. Her blood tests on admission were as follows; White Blood Cell count (WBC) 11.91 10e3/µL (normal range 4.4 -11.3 10e3/µL), haemoglobin 12 g/dL (normal range 11.7 -16.1 g/dL), platelet count 175 10e3/µL ( normal range 152-396 10e3/µL), urea 38 mg/dL (normal range 16.6-48.5 mg/dL), creatinine 0.5 mg/dL (normal range 0.5-0.9 mg/dL), glucose 83.5 mg/dL (normal range 74 -109 mg/dL), sodium 130 AbstractBackground: Myocarditis is a focal or diffuse inflammatory disease of the myocardium. Prevalence of arrhythmia associated with myocarditis has been reported as merely 18%. Sinus arrhythmias in myocarditis are uncommon. Case report: Here we describe a case of a 33-years-old female patient with myocarditis. She developed sinus arrest lasting for 15 seconds and lost consciousness and a seizure was observed in that period. A new rhythm occurred spontaneously. Temporary transvenous pacemaker lead was implanted due to recurrent sinus pause episodes. The patient was on sinus rhythm on the third day of admission. Cardiac Magnetic Resonance Imaging (CMRI) showed subendocardial enhancement, highly consistent with acute myocarditis. The patient was discharged with normal sinus rhythm.