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Sudden death caused by giant cell myocarditis following coronary artery bypass
1Department of Histopathology, Royal Berkshire Hospital, Reading, England.
Insights
Idiopathic giant cell myocarditis (GCM) is a rare condition. This case suggests GCM may occur post-surgery, potentially mimicking myocardial infarction.
Area of Science:
- Cardiology
- Pathology
Background:
- Giant cell myocarditis (GCM) is a rare and often fatal cardiac condition.
- Idiopathic GCM lacks a clear underlying cause, presenting diagnostic challenges.
Observation:
- A patient with a history of angina underwent coronary artery bypass surgery.
- Two months post-surgery, the patient experienced sudden death.
- Autopsy revealed isolated giant cell myocarditis.
Findings:
- This case highlights a potential association between coronary artery bypass surgery and the development of GCM.
- Foreign-body reaction is proposed as a possible trigger for GCM in postoperative patients.
- GCM can present atypically, mimicking acute myocardial infarction.
Implications:
- The findings suggest expanding the differential diagnosis for GCM in postoperative patients.
- Recognizing GCM as a cause of sudden cardiac death post-surgery is crucial for accurate diagnosis.
- This case underscores the importance of considering myocarditis in unexplained sudden cardiac deaths.
Abstract:
An unusual case of idiopathic giant cell myocarditis (GCM) is described. The patient had a 5-year history of stable and unstable angina, poorly controlled by medical treatment. He underwent a successful coronary artery bypass, but 2 months later died suddenly at home. A coroner's autopsy revealed isolated GCM. This newly described possible association between the surgery and the condition is discussed and the pertinent literature is reviewed. We suggest that the list of causes of GCM in postoperative patients should also include foreign-body reaction. Our findings support the view that myocarditis occasionally masquerades as fatal acute myocardial infarction.