Dilated Cardiomyopathy as a Result of Coxsackie B Virus Myocarditis

Dilated cardiomyopathy (DCM) is a myocardial disease that is characterized by left ventricular or biventricular dilation and impairment of systolic function. The etiology is often unknown although it has been thought that DCM may be a consequence of viral myocarditis. The most commonly implicated viruses in the development of myocarditis include coxsackie B virus, hepatitis, parvovirus, cytomegalovirus, influenza virus, and adenovirus. DCM carries a poor prognosis and high rates of mortality, therefore early diagnosis and treatment are imperative. A 47-year-old male presented with atypical chest pain, along with progressive dyspnea. The patient also endorsed symptoms consistent with acute viral syndrome roughly one week prior to presenting to the hospital. The patient initially presented in cardiogenic shock. An initial workup including an echocardiogram was done and showed an ejection fraction of 10-15% with severe left ventricular and left atrial dilation. Left-sided cardiac catheterization revealed nonobstructive coronary artery disease. The patient was placed on mechanical circulatory and inotropic support and was transferred to the cardiovascular intensive care unit. Cardiac MRI was done and showed a moderately sized pericardial effusion along with signs indicative of myocarditis. Serologic testing was positive for coxsackie B virus type IV antibodies. The patient's clinical picture improved as circulatory and inotropic support was removed and the patient was discharged with close outpatient follow-up and evaluation for cardiac transplant.