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Acute right ventricular myocarditis presenting with chest pain and syncope
Jennifer Mancio1, Nuno Bettencourt, Marco Oliveira
1Department of Cardiology, Hospital Center of Vila Nova de Gaia and Espinho, Vila Nova de Gaia, Portugal.
BMJ Case Reports
|October 8, 2013
Summary
This case report highlights acute viral right ventricular myocarditis, a rare condition. It emphasizes considering isolated right ventricular involvement in myocarditis diagnoses, especially with right ventricular enlargement.
Area of Science:
- Cardiology
- Infectious Diseases
- Cardiac Imaging
Background:
- Myocarditis typically affects both ventricles equally.
- Right ventricular (RV) predominant myocarditis is infrequently documented.
- Understanding atypical presentations is crucial for accurate diagnosis.
Observation:
- A case of acute viral myocarditis with isolated RV involvement is presented.
- The patient experienced chest pain, syncope, and grade 3 atrioventricular block.
- Cardiac MRI revealed RV dilatation and free wall hypokinesia with RV late enhancement.
Findings:
- Elevated anti-Coxsackie A9 virus neutralising IgM antibodies confirmed viral etiology.
- Diagnostic findings were confined to the right ventricle, excluding left ventricular involvement.
- The presentation mimicked other causes of RV enlargement.
Implications:
- This case underscores that myocarditis can manifest with predominant or isolated right ventricular pathology.
- Clinicians should include RV myocarditis in the differential diagnosis for unexplained RV enlargement.
- Accurate diagnosis of RV myocarditis is essential for appropriate management and patient outcomes.
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