Thank you, Dave, for presenting a fascinating case of a middle-aged man with history of cocaine use, who presented with acute on chronic worsening of shortness of breath and palpitations. He was found on admission to have monomorphic VT and isolated RV dilation on echo. He ended up getting a cardiac MRI and a biopsy which showed giant cells. This led to an interesting ddx of giant cell myocarditis vs cardiac sarcoid vs ARVD!
SamMy (Sam&Myung) _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
- Unlike other cardiomyopathies, the clinical course of giant cell myocarditis is characterized by acute or fulminant deterioration in LV systolic function and frequent ventricular arrhythmias
- Subclinical cardiac involvement is present in up to 70% of patients with sarcoidosis.
_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Giant Cell Myocarditis (GCM)
- Rare and frequently fatal type of autoimmune myocarditis
- It is a T lymphocyte-mediated inflammation and is associated with systemic autoimmune disorder in about 20% of cases
- In contrast to clinical course of other cardiomyopathies, the clinical course of GCM is characterized by acute or fulminant deterioration in LV systolic function (despite HF treatment), frequent ventricular arrhythmias, and heart block!
- Prognosis (even with immunosuppressive treatment) is generally very poor – in one series, rate of death or cardiac transplant was 90% and median survival from onset of symptoms was <6 months! There is data suggesting that immunosuppressive agents can improve survival in patients, but this is observational data based on small patient size.
- Check out this review article on GCM: PMID: 27922771
See our Prior Pearls on Cardiac Sarcoidosis:
See our Prior Pearls on ARVD: