Biopsy detection and clinical management of acute lymphocytic myocarditis in pregnancy

Acute lymphocytic myocarditis in pregnancy is rare, with no established management guidelines to date. A 40-year-old woman at 34 weeks of gestation complained of shortness of breath upon exertion. An electrocardiogram revealed broad ST elevation, and echocardiography showed diffuse impairment of left ventricular contractility. The patient was immediately transferred to our hospital for suspected takotsubo cardiomyopathy. We considered myocarditis based on the patient's prior cold-like symptoms and additional examination. Myocardial biopsy revealed lymphocyte infiltration, which confirmed acute lymphocytic myocarditis. Although there were no signs of heart failure or conduction disturbance under catecholamine, her hemodynamics were weak. Emergency cesarean section was performed because of possible hemodynamic failure during the remaining course of pregnancy. Both the mother and baby were discharged without any subsequent events. If acute myocarditis is suspected during pregnancy, prompt myocardial biopsy is crucial for timely pathological diagnosis and treatment decisions. Clinicians should consider premature delivery prior to a possible failure in maternal hemodynamics. <Learning objective: Acute lymphocytic myocarditis in pregnancy is rare; the condition is difficult to diagnose, and management protocols have not been established. If acute myocarditis is suspected during pregnancy, early myocardial biopsy is vital for prompt diagnosis and treatment decisions. Premature delivery should be considered if maternal hemodynamics is expected to destabilize.>.