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).