Case Presentation
A 21-year-old male presented after a witnessed seizure. Shortly after the presentation, he had a cardiac arrest and was successfully resuscitated. An electrocardiogram revealed sinus tachycardia with left bundle branch block. Serum troponin-I was elevated (31 ng/ml). Urine toxicology screen ruled out recreational drug use.
A transthoracic echocardiogram (TTE) revealed a left ventricular (LV) ejection fraction (EF) of 30% and hypokinesia of the MV segment of the LV with normal contractility of the apex and basal segments (Video A). Left and right heart catheterization revealed normal coronary arteries, normal right heart filling pressures, and a preserved cardiac output (Figure A). A viral myocarditis panel including Coxsackie B, EBV, CMV, HHV-6, Parvovirus B-19, and HSV was negative. A cardiac MRI (Video B, C, D, E) revealed severe hypokinesis of the MV segment of the LV with normal contractility of apical and basal segments. There was no evidence of myocardial edema and there was no abnormal delayed gadolinium enhancement to suggest myocardial infarction, scarring, or infiltrative disease (Figure B). He improved clinically with supportive measures and a TTE before discharge showed an LVEF of 50% with normal LV contractility (Video F).