Case Report: Probable Myocarditis After Covid-19 mRNA Vaccine in a Patient With Arrhythmogenic Left Ventricular Cardiomyopathy

Arrhythmogenic left ventricular cardiomyopathy (ALVC) is a rare heritable heart-muscle disorder characterized by a progressive loss of left ventricular myocardium and its replacement by fibrofatty tissue. Myocarditis is an inflammatory disease of the heart that may occur secondary to infections, immune system activation or exposure to drugs. Hot phases of ALVC present with chest pain and troponin rise, mimicking acute viral myocarditis and indicate a progression of the disease. Recently, myocarditis has also been described as an infrequent complication of coronavirus disease 2019 (Covid-19) mRNA vaccines. We herein report for the first time a case of probable myocarditis induced by Covid-19 vaccine in a patient with previous medical history of ALVC. We aim to highlight the common characteristics of ALVC and Covid-19 vaccine myocarditis and work through the differential diagnosis of these two entities.

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Possibly Late-Onset Arrhythmogenic Right Ventricular Cardiomyopathy: Unique Triglyceride Deposition by Analysis of Lipid Contents

Clinical Medicine Insights Case Reports ◽

10.1177/1179547619828715 ◽

2019 ◽

Vol 12 ◽

pp. 117954761982871

Author(s):

Kentaro Yamamoto ◽

Xin Guo ◽

Ken-ichi Mizutani ◽

Nozomu Kurose ◽

Motona Kumagai ◽

...

Keyword(s):

Right Ventricular ◽

Late Onset ◽

Arrhythmogenic Right Ventricular Cardiomyopathy ◽

Ventricular Myocardium ◽

Cholesterol Content ◽

Left Ventricular ◽

Left Ventricular Myocardium ◽

Ventricular Cardiomyopathy ◽

Lipid Contents ◽

The Right

We presented an unusual arrhythmogenic right ventricular cardiomyopathy (ARVC) case of a late-60s elderly man’s death, due to severe pericardial/pleural effusion and ascites, and arrhythmic events, with unique pathological features. The hypertrophic heart grossly displayed yellowish to yellow-whitish predominantly in the variably thinned wall of the dilated right ventricle. Microscopic findings showed diffuse fatty/fibrofatty replacement in not only the right but left ventricular myocardium, together with an outer lymphoplasmacytic infiltrate. According to the lipid contents analysis, the triglyceride content, but not the cholesterol content, in our patient’s right and left ventricular cardiac muscle was much higher than that in the control subject. We propose that this unique triglyceride deposition in our possibly late-onset ARVC case might be one of new clues to understand its enigmatic cause. Further prospective studies are needed to validate the presence and significance of a greater volume of triglyceride deposit, after collecting and investigating a larger number of early and late-onset ARVC cases examined.

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Cardiac arrest as first presentation of arrhythmogenic left ventricular cardiomyopathy due to Filamin C mutation: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytab422 ◽

2021 ◽

Vol 5 (11) ◽

Author(s):

Navneet Kandhari ◽

Shafik Khoury ◽

Elijah R Behr ◽

Chris Miles

Keyword(s):

Cardiac Arrest ◽

Ventricular Myocardium ◽

Left Ventricular ◽

Left Ventricular Myocardium ◽

Arrhythmogenic Cardiomyopathy ◽

Ventricular Cardiomyopathy ◽

Pathogenic Variation ◽

Malignant Arrhythmia ◽

Gene Panels ◽

Filamin C

Abstract Background Arrhythmogenic left ventricular cardiomyopathy (ALVC) is a rare form of arrhythmogenic cardiomyopathy characterized by fibrofatty replacement of left ventricular myocardium, malignant arrhythmia, and sudden cardiac death. The definition incorporates several genetic causes, including pathogenic variation in the Filamin C gene (FLNC). Although awareness of ALVC has improved, identification remains challenging and diagnostic criteria continue to evolve. Case summary A 50-year-old athletic male was admitted following an out-of-hospital cardiac arrest due to ventricular tachycardia (VT) whilst playing football. Coronary angiography revealed unobstructed epicardial vessels and the diagnosis of ALVC was suggested by cardiovascular magnetic resonance imaging, which demonstrated a mildly dilated and moderately impaired left ventricle with epicardial late gadolinium enhancement in the basal to mid-lateral walls and subendocardial septum. Initial testing with a cardiomyopathy and arrhythmia gene panel was negative but extended testing uncovered a likely pathogenic variant in FLNC. Subsequently, the patient experienced a recurrence of sustained VT necessitating implantable cardioverter-defibrillator (ICD) therapies, ultimately undergoing a combined epicardial and endocardial VT ablation 4 years after presentation. Six months post-ablation, he was asymptomatic and his arrhythmia rendered quiescent. Discussion Arrhythmogenic cardiomyopathy should be considered in the evaluation of an initially unexplained cardiac arrest. This case characterizes the clinical features of a patient with FLNC cardiomyopathy and emphasizes the utility of genetic testing using modern gene panels in patients with comparable phenotypes. We also demonstrate that optimal medical therapy with antiarrhythmic drugs, exercise restriction, ICD insertion, and catheter ablation can be useful in the management of ALVC with positive outcomes

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Abstract 3013: Myocardium at Risk of Infarction during Acute Ischemia is Accurately Measured after Revascularization by MRI in Humans

Circulation ◽

10.1161/circ.116.suppl_16.ii_674-c ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Marcus Carlsson ◽

Erik Hedstrom ◽

Einar Heiberg ◽

Hakan Arheden

Keyword(s):

At Risk ◽

Visual Assessment ◽

Ventricular Myocardium ◽

Left Ventricular ◽

Acute Ischemia ◽

Left Ventricular Myocardium ◽

Myocardium At Risk ◽

St Elevation ◽

The Difference ◽

First Time

PURPOSE: The size of an infarct caused by coronary occlusion mainly depends on the duration of ischemia and the size of the ischemic myocardium, called myocardium at risk (MaR). T2-STIR imaging (visualizing oedema) has been shown to depict MaR in dogs. However, this has not been validated in humans. Therefore the purpose of this study was to validate the measurement of MaR by MRI against SPECT. METHODS: 7 patients (69±8 years, all male) with ST-elevation infarction treated by PCI were included. Technetium-labelled tetrofosmin was injected during ongoing ischemia before opening of the occluded vessel. SPECT was performed after concluded PCI and cardiac MRI after 3±3 days. MaR was measured as absent perfusion on SPECT and oedema on MRI, and expressed in percent of the left ventricular myocardium. The observer of the MRI data was blinded to the SPECT results. The localisation of transmural ischemia by the two methods was compared by visual assessment. RESULTS: The difference between SPECT and MRI for measurement of MaR was 0±9 % (mean±SD). The localization of transmural ischemia agreed between the two methods (Fig. 1 ) and expressed on vessel basis, MRI and SPECT showed 100 % concordant results. CONCLUSIONS: This study has showed for the first time in humans that T2-STIR accurately can determine myocardium at risk. This can be used in clinical research when studying new therapies for reducing infarct size. Fig 1 : Short axis slices of left ventricle showing inferior defect on SPECT (arrows, left panel) corresponding to the oedema signal on T2-STIR MRI (arrows, middle panel). For comparison, delayed enhancement in right panel shows subendocardial infarction (arrows).

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Arrhythmogenic left ventricular cardiomyopathy

BJR|case reports ◽

10.1259/bjrcr.20190079 ◽

2020 ◽

Vol 6 (1) ◽

pp. 20190079

Author(s):

Seyedeh Mojdeh Mirmomen ◽

Andrew Jay Bradley ◽

Andrew Ernest Arai ◽

Arlene Sirajuddin

Keyword(s):

Right Ventricular ◽

Cardiac Death ◽

Arrhythmogenic Right Ventricular Cardiomyopathy ◽

Ventricular Myocardium ◽

Left Ventricular ◽

Ventricular Cardiomyopathy ◽

Cardiotoxic Effect ◽

Life Threatening ◽

Muscle Disorder ◽

The Right

Arrhythmogenic ventricular cardiomyopathy (AVC) is a heritable heart muscle disorder characterized by fibrofatty infiltration of the myocardium. Intramyocardial fat deposition is considered arrhythmogenic and predisposes patients to life-threatening arrhythmias and sudden cardiac death. The classic subtype of AVC is characterized by fibrofatty replacement of the right ventricular myocardium (i.e. arrhythmogenic right ventricular cardiomyopathy). In advanced cases of arrhythmogenic right ventricular cardiomyopathy, the left ventricle may be involved as well. Predominantly left ventricular involvement by AVC is exceedingly rare and lack of specific diagnostic criteria as well as its potential cardiotoxic effect make its diagnosis challenging and of high importance.

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The left ventricular myocardium in children at early stages of diabetes mellitus: Functional and morphometric parameters

Problems of Endocrinology ◽

10.14341/probl11389 ◽

2003 ◽

Vol 49 (1) ◽

pp. 13-17

Author(s):

I. G. Kuznetsova ◽

О. V. Filaretova ◽

T. L. Nastausheva ◽

T. G. Stolnikova ◽

О. V. Zazulina

Keyword(s):

Ventricular Myocardium ◽

Left Ventricular ◽

Morphometric Parameters ◽

Control Group ◽

Left Ventricular Myocardium ◽

First Year ◽

Healthy Children ◽

End Diastolic Volume ◽

History Of ◽

Group A

Its morphometric parameters (myocardial mass according to the procedure described by R. Devereuxe, end-diastolic volume and their ratio). Sixteen healthy children of the same age formed the control group. A gradual redistribution of transmitral flow towards the atrial systolic phase was found in children with a more than 5-year history of diabetes, which seems to be associated impaired L V myocardial relaxation due to myocardial metabolic changes and to the occurrence of specific microangiopathies. The found changes progressed with time and correlated with the appearance ofperipheral distal neuropathy. Within the first year of diabetes, there was a transient reduction in LV contractility, which appears to be associated with myocardial metabolic imbalance during the decompensation of the disease. There is a trend to LV myocardial hypertrophy 10years after the onset of the disease.

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Calcifying myocarditis mimicking an intracardiac tumor on fetal echocardiography

Cardiology in the Young ◽

10.1017/s1047951100001438 ◽

1993 ◽

Vol 3 (2) ◽

pp. 158-160 ◽

Cited By ~ 1

Author(s):

Renate Oberhoffer ◽

Uwe Hillen ◽

Dieter Lang

Keyword(s):

Fetal Echocardiography ◽

Viral Myocarditis ◽

Ventricular Myocardium ◽

Left Ventricular ◽

Left Ventricular Myocardium ◽

Intracardiac Mass ◽

Intracardiac Tumor ◽

Histological Results ◽

Echocardiographic Findings

SummaryWe report echocardiographic findings of an intracardiac mass in a hydropic fetus who died after four weeks of follow-up. Within that period, the left ventricular myocardium had developed extensive echo-dense patterns suggesting tumorous infiltration. Autopsy revealed extreme calcification of the mitral valve, which had mimicked a tumorous mass on fetal echocardiography. The histological results were consistent with viral myocarditis.

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