Debadatta Mukhopadhyay
Medical College, Kolkata - West Bengal University of Health Sciences, India
Title: Myocarditis revisited: few unusual cases of myocarditis – experience in an Indian tertiary care centre
Biography
Biography: Debadatta Mukhopadhyay
Abstract
Introduction: Myocarditis is a known complication of various febrile illnesses of infective and noninfective etiology. Here we describe some atypical causes of myocarditis, their clinical profile and outcome.
Case 1: A two-year-old girl presented with low grade fever and respiratory distress for three days. Significant clinical findings were cardiomegaly, gallop rhythm and tender hepatomegaly. Diuretics and inotropes as Dobutamine and Milrinone were commenced. Echocardiography revealed gross dilatation of LV and severe systolic dysfunction (EF 31%) (Fig1a). Absolute eosinophil counts dramatically reduced to 288 after 10 days. There was also improvement of cardiac function (EF-42 %) (Fig 1b). On follow up, LV dilatation and mild to moderate dysfunction persisted.
A five month old child was brought to the A and E with incessant crying. She had tachycardia (HR 198/min, sinus rhythm), High BP (97th centile) and cardiomegaly. She had been bitten by a scorpion two hour back. There was LV dilatation and severe cardiac systolic dysfunction (EF 33%). CPK MB and Trop T levels were raised as were the inflammatory markers like ESR and CRP. The tachycardia and hypertension settled gradually after starting oral Prazosin and intravenous Labetalol infusion. After few days the cardiac function improved and normalized on follow up with cardiac chambers resuming their normal size.
Case 2: Myocarditis is a known complication of Dengue fever in the tropical countries, characterized by LV dilatation and dysfunction. A six year old boy presented with shock with history of fever for last five days. Patient received adequate fluids and inotropes including Milrinone and Levosimendan. Later, IVIg was also given which led to marked improvement in function. There was Leukocytosis, thrombocytopenia and Dengue serology (IgM and IgG) was positive. In addition to severe systolic dysfunction (EF 33%), pericardial effusion, echocardiography also showed unusual hypertrophy of the interventricular septum (IVSd 1.3cm: >4 z scores, LVPWd = 1cm, >4 z scores) (Fig2a, b and c). On D6 PICU stay, LV Ejection fraction was found to have significantly increased to 60% (Fig 3a and 3b).