Acute fulminating viral myocarditis: clinically mimicking ARDS

Abstract

Viral myocarditis usually presented with influenza like manifestations, cardiac symptoms and signs related to myocarditis. We are presenting a case which was clinically mimicking acute respiratory distress syndrome but careful history taking with chest x-ray examination saves life of the patient. Key words: viral myocarditis, ARDSIntroduction ARDS (acute respiratory distress syndrome) is a life threatening condition of the respiratory system. Main causes of ARDS are severe infections (pulmonary and extra-pulmonary); trauma (pulmonary and extra-pulmonary); and others (inhalation of toxins, aspiration of gastric content, near drowning, pancreatitis, drugs etc.).1 The diagnosis of ARDS is based on acute onset of respiratory distress, bilateral infiltrates on chest radiology, severe hypoxia with PaO2/FiO2 ratio = 200 (PaO2 = partial pressure of arterial oxygen; FiO2 = percentage of inspired oxygen), identification of etiological factor and exclusion of cardiogenic pulmonary edema by pulmonary artery wedge pressure = 18 mm Hg or absence of clinical evidence of left atrial hypertension.2 As measurement of pulmonary capillary wedge pressure is invasive and has many fallacies, in usual clinical practice left heart disease is excluded by clinical assessment as well as absence of cardiomegaly. Differential diagnosis of ARDS includes left ventricular failure, acute interstitial pneumonia, diffuse alveolar haemorrhage, acute eosinophilic pneumonia, hypersensitivity pneumonitis, post obstructive pulmonary edema and bilateral pneumonia.