B49-21 From Myocarditis to Acute Heart Failure: A Case of Rapid Decompensation and Recovery

Abstract Acute myocarditis is a well-known cause of dilated cardiomyopathy (DCM). While the clinical course can range from mild to full blown acute decompensated heart failure (ADHF), progression to severe ventricular dysfunction and DCM is relatively rare. We present a case of acute myocarditis in a previously healthy individual, leading to rapid development of ADHF, highlighting the diagnostic and therapeutic challenges in such presentations. A 28-year-old male presented with acute onset shortness of breath and productive cough with pink frothy sputum. The patient had no significant medical or family history and reportedly vaped marijuana daily. He worked in construction. He reported no recent viral infections. At presentation the patient was afebrile, hypertensive, tachycardic, tachypnea and hypoxemia. His labs were significant for leukocytosis, an elevated BNP, an elevated creatinine kinase, an elevated troponin, an elevated CRP and lactic acidosis. Cultures taken were negative, as was the procalcitonin, ANA and CRP. EKG was sinus tachycardia. CTA of the chest was significant for bilateral ground glass opacifications in the apical and lower posterior lobes bilaterally suggestive of pulmonary edema. The patient was admitted for acute hypoxic respiratory failure with differentials including atypical pneumonia, EVALI, cardiogenic pulmonary edema and vasculitis. Broad spectrum antibiotics and bilevel ventilation was started. Bedside POCUS showed a reduced LV systolic function without wall motion abnormalities and a formal echocardiogram confirmed our initial findings. There was no valvopathy. Interestingly there was no E/A reversal or dilation of the ventricles. Diuresis was initiated with excellent urine output and patient was weaned off bilevel ventilation within 24 hours. Antibiotics were stopped after final cultures resulted. A repeat echocardiogram was done that showed improvement in EF. Determining the etiology of ADHF in an otherwise healthy individual can be tricky. Ischemia should be ruled out, but myocarditis should remain high on the differential in someone without cardiovascular risk factors. A cardiac MRI and endomyocardial biopsy are both useful in confirming myocarditis and assessing the extent damage. Treatment is supportive with guideline directed medical therapy for heart failure. If left untreated, remodeling and fibrosis could eventually lead to chronic ventricular dilation. Early recognition and initiation of therapy are essential to prevent chronic cardiac changes and reduce mortality. This case contributes to the literature about myocarditis as a reversible cause of DCM. It also further emphasizes the importance of maintaining a high suspicion of index in a young and healthy individual with newly diagnosed heart failure. This abstract is funded by: None