JACC. Case reports最新文献

One-Step Hybrid MIDCAB, Complex PCI, and TAVR in a 94-Year-Old Male With Early Cardiogenic Shock. 94岁男性早期心源性休克的一步混合MIDCAB、复杂PCI和TAVR。

JACC. Case reports Pub Date : 2025-10-09 DOI: 10.1016/j.jaccas.2025.105671

Daniel Tran, Elio Rodriguez, Alexandra Tuluca, Christian Witzke

{"title":"One-Step Hybrid MIDCAB, Complex PCI, and TAVR in a 94-Year-Old Male With Early Cardiogenic Shock.","authors":"Daniel Tran, Elio Rodriguez, Alexandra Tuluca, Christian Witzke","doi":"10.1016/j.jaccas.2025.105671","DOIUrl":"https://doi.org/10.1016/j.jaccas.2025.105671","url":null,"abstract":"<p><strong>Background: </strong>Management of a complex multivessel disease with concomitant severe aortic stenosis remains clinically challenging, particularly in high-risk elderly patients.</p><p><strong>Case summary: </strong>We describe the first known case of a nonagenarian with acute coronary syndrome and early cardiogenic shock who underwent a one-step hybrid minimally invasive direct coronary artery bypass, percutaneous coronary intervention, and transcatheter aortic valve replacement. The procedure was challenging and required unplanned escalation to extracorporeal membrane oxygenation support but was successfully performed with durable results at 1-year follow-up.</p><p><strong>Discussion: </strong>The constant evolution in the management of combined structural heart and coronary artery disease provides new opportunities for alternative hybrid approaches that may better address patients with challenging comorbidities and prohibitively high surgical risk.</p><p><strong>Take-home messages: </strong>Hybrid coronary revascularization with combined transcatheter aortic valve replacement is a viable alternative in unacceptably high surgical risk patients. This case highlights the crucial role of a multidisciplinary heart team to accomplish excellent short- and long-term durable results.</p>","PeriodicalId":14792,"journal":{"name":"JACC. Case reports","volume":" ","pages":"105671"},"PeriodicalIF":0.0,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145251087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Cardiopulmonary Exercise Testing–Guided Optimization of Pacemaker Rate-Response in an Endurance Athlete With Sinus Node Dysfunction 心肺运动试验指导下窦房结功能障碍耐力运动员起搏器率反应优化

JACC. Case reports Pub Date : 2025-10-08 DOI: 10.1016/j.jaccas.2025.105278

Paishiun Nelson Hsieh MD, PhD , Katherine Falvey BS , Andreas Kontopidis BS , Jessica Burr BS, MS , Mark É. Czeisler MD , Marius Chukwurah MD , Katie Stewart CNP , Timothy W. Churchill MD , James Sawalla Guseh MD , Eugene H. Chung MD

{"title":"Cardiopulmonary Exercise Testing–Guided Optimization of Pacemaker Rate-Response in an Endurance Athlete With Sinus Node Dysfunction","authors":"Paishiun Nelson Hsieh MD, PhD , Katherine Falvey BS , Andreas Kontopidis BS , Jessica Burr BS, MS , Mark É. Czeisler MD , Marius Chukwurah MD , Katie Stewart CNP , Timothy W. Churchill MD , James Sawalla Guseh MD , Eugene H. Chung MD","doi":"10.1016/j.jaccas.2025.105278","DOIUrl":"10.1016/j.jaccas.2025.105278","url":null,"abstract":"<div><h3>Background</h3><div>Athletes with a permanent pacemaker for sinus node dysfunction can experience exercise intolerance related to suboptimal rate-response pacing, often isolated to periods of peak or prolonged effort. Nominal pacemaker rate modulation settings do not recapitulate physiological exercise well.</div></div><div><h3>Case Summary</h3><div>We present a case of a 70-year-old lifelong runner with implanted permanent pacemaker for sinus node dysfunction presenting with exercise intolerance and dyspnea on exertion. A combined maximum effort cardiopulmonary exercise test with device interrogation produced an optimized pacemaker settings profile which resolved his symptoms.</div></div><div><h3>Discussion</h3><div>Highly active patients with sinus node dysfunction depend on rate-response pacing during exercise. Optimized pacemaker function for high intensity sports can relieve symptoms and improve performance. Our case highlights the importance of an athlete-tailored approach combining maximum effort metabolic, exercise, and device testing.</div></div>","PeriodicalId":14792,"journal":{"name":"JACC. Case reports","volume":"30 31","pages":"Article 105278"},"PeriodicalIF":0.0,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145242182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Sudden Cardiac Arrest on the Treadmill 跑步机上的心脏骤停

JACC. Case reports Pub Date : 2025-10-08 DOI: 10.1016/j.jaccas.2025.105334

Thomas Diamond MD, Cesar Joel Benites-Moya MD, Abhinav Karan MD, Khalid Shakfeh MD, Anvit Reddy MD, Fabiana Rollini MD, Ali Zgheib MD

{"title":"Sudden Cardiac Arrest on the Treadmill","authors":"Thomas Diamond MD, Cesar Joel Benites-Moya MD, Abhinav Karan MD, Khalid Shakfeh MD, Anvit Reddy MD, Fabiana Rollini MD, Ali Zgheib MD","doi":"10.1016/j.jaccas.2025.105334","DOIUrl":"10.1016/j.jaccas.2025.105334","url":null,"abstract":"<div><h3>Background</h3><div>A 28-year-old healthy woman collapsed while running on a treadmill, with no known past medical history or conditions.</div></div><div><h3>Case Summary</h3><div>Initial angiography suggested left main spontaneous coronary artery dissection (SCAD), but coronary computed tomography angiography (CCTA) revealed an anomalous left main coronary artery arising from the right sinus with an intramural interarterial course. Surgical correction was performed.</div></div><div><h3>Discussion</h3><div>This case demonstrates the diagnostic challenges in a young patient presenting with sudden cardiac arrest during exertion, initially presumed to be SCAD; further evaluation with CCTA revealed no evidence of SCAD. The imaging uncovered an anomalous origin of the left main coronary artery from the right coronary sinus with an interarterial and intramural course, which is a high-risk anomaly associated with sudden cardiac death at a young age.</div></div><div><h3>Take-Home Messages</h3><div>Anomalous courses of the left main coronary artery are rare and associated with sudden cardiac death, particularly in young individuals. CCTA is the gold standard for diagnosis, with surgical intervention being the definitive treatment.</div></div>","PeriodicalId":14792,"journal":{"name":"JACC. Case reports","volume":"30 31","pages":"Article 105334"},"PeriodicalIF":0.0,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145242205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Uncorrected Tetralogy of Fallot With Pulmonary Atresia in an Adult 未纠正的法洛四联症合并肺闭锁一例成人

JACC. Case reports Pub Date : 2025-10-08 DOI: 10.1016/j.jaccas.2025.105331

Charlie J. Sang III MD , Lunise Benjamin DNP , Elman G. Frantz MD , Michael Yeung MD

{"title":"Uncorrected Tetralogy of Fallot With Pulmonary Atresia in an Adult","authors":"Charlie J. Sang III MD , Lunise Benjamin DNP , Elman G. Frantz MD , Michael Yeung MD","doi":"10.1016/j.jaccas.2025.105331","DOIUrl":"10.1016/j.jaccas.2025.105331","url":null,"abstract":"<div><h3>Background</h3><div>Management of tetralogy of Fallot with pulmonary atresia (ToF-PA) in adults is not well established.</div></div><div><h3>Case</h3><div>A 37-year-old woman with ToF-PA presented with dyspnea. Left and right heart catheterization revealed a large major aortopulmonary collateral artery (MAPCA) to the left pulmonary artery supplying confluent pulmonary arteries and with normal pulmonary vascular resistance. She underwent fenestrated ventricular septal defect closure, ligation of the MAPCA, and right ventricle–to–pulmonary artery conduit placement. She developed acute right heart failure, with distal conduit stenosis with the residual MAPCAs. A 26 × 12 mm stent was deployed, with relief of conduit stenosis. The MAPCAs were closed with vascular plug and coils.</div></div><div><h3>Discussion</h3><div>Surgical repair can be recommended with confluent pulmonary arteries of adequate size, MAPCAs in which unifocalization or ligation/coiling can occur, and absence of severe pulmonary vascular disease. Surgery in adults may contribute significantly to mortality, with unclear benefit.</div></div><div><h3>Take-Home Messages</h3><div>Unrepaired ToF-PA in adults is rare, and careful consideration must be given to each patient given the lack of standardized treatment protocols. Multidisciplinary teams are essential for preoperative planning and management of postoperative complications.</div></div>","PeriodicalId":14792,"journal":{"name":"JACC. Case reports","volume":"30 31","pages":"Article 105331"},"PeriodicalIF":0.0,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145242266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Beyond Tachycardia-Induced Cardiomyopathy 超越心动过速引起的心肌病：abcc9相关扩张性心肌病和家族性心房颤动。

JACC. Case reports Pub Date : 2025-10-08 DOI: 10.1016/j.jaccas.2025.105302

Alexander Kong MD , Teresa Bernardes MD , Elona Rrapo-Kaso MD , Alexies Ramirez MD , Steve Carlan MD

{"title":"Beyond Tachycardia-Induced Cardiomyopathy","authors":"Alexander Kong MD , Teresa Bernardes MD , Elona Rrapo-Kaso MD , Alexies Ramirez MD , Steve Carlan MD","doi":"10.1016/j.jaccas.2025.105302","DOIUrl":"10.1016/j.jaccas.2025.105302","url":null,"abstract":"<div><h3>Background</h3><div>Tachycardia-induced cardiomyopathy (TICM) is typically reversible with rhythm control, but individual susceptibility remains poorly understood and may reflect genetic predisposition.</div></div><div><h3>Case Summary</h3><div>A 66-year-old woman with paroxysmal atrial fibrillation (AF) presented with new-onset heart failure. Genetic testing identified a likely pathogenic heterozygous <em>ABCC9</em> gene variant (c.3892+2T>C), not previously associated with dilated cardiomyopathy or AF. <em>ABCC9</em> loss-of-function mutations have been linked with cardiac channelopathies and cardiomyopathies. Ventricular function improved with rhythm control and medical therapy.</div></div><div><h3>Discussion</h3><div>This case illustrates the potential role of <em>ABCC9</em> mutations in arrhythmia-induced cardiomyopathy beyond pure TICM. Although this variant has not been previously reported in affected individuals, existing models support its pathogenicity. The co-occurrence of prolonged QT, familial AF, and dilated cardiomyopathy underscores the value of genetic testing in cardiac disease.</div></div><div><h3>Take-Home Messages</h3><div>Genetic testing may reveal causes in atypical or treatment-resistant cardiomyopathies and arrhythmias. This novel <em>ABCC9</em> variant suggests a genetic contribution to AF-induced cardiomyopathy beyond the expected course of TICM.</div></div>","PeriodicalId":14792,"journal":{"name":"JACC. Case reports","volume":"30 31","pages":"Article 105302"},"PeriodicalIF":0.0,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145023397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Imaging Pitfalls in the Detection of Infiltrative Cardiomyopathies 浸润性心肌病检测中的影像学缺陷

JACC. Case reports Pub Date : 2025-10-08 DOI: 10.1016/j.jaccas.2025.105321

Patricia M. Carey MD , Grace Hagan MD , John P. Bois MD

{"title":"Imaging Pitfalls in the Detection of Infiltrative Cardiomyopathies","authors":"Patricia M. Carey MD , Grace Hagan MD , John P. Bois MD","doi":"10.1016/j.jaccas.2025.105321","DOIUrl":"10.1016/j.jaccas.2025.105321","url":null,"abstract":"<div><h3>Background</h3><div>Despite increasing recognition of infiltrative cardiomyopathies, the heterogeneous group of diseases remains difficult to diagnose.</div></div><div><h3>Case Summary</h3><div>We present an 82-year-old man with septal basal thickening initially thought to be hypertrophic cardiomyopathy. Further imaging was suspicious for sarcoidosis, but after several years without clinical improvement and the interval development of concentric hypertrophy, he was diagnosed with cardiac amyloidosis.</div></div><div><h3>Discussion</h3><div>Advanced imaging modalities are frequently used to evaluate suspected infiltrative cardiomyopathies. However, the effectiveness of imaging can be limited by the variable presentations of both sarcoid and amyloid. In this case, cardiac amyloidosis initially appeared on imaging with features characteristic of cardiac sarcoidosis on both positron emission tomography and cardiac magnetic resonance. Despite advancements in imaging technology, diagnostic limitations persist, potentially leading to misdiagnosis and delayed treatment.</div></div><div><h3>Take-Home Messages</h3><div>Despite increasing recognition, cardiac amyloid and cardiac sarcoid are difficult to diagnose and require a high degree of clinical suspicion. Multimodality imaging can help discriminate between cardiomyopathies. However, limitations with current imaging modalities may lead to further diagnostic uncertainty.</div></div>","PeriodicalId":14792,"journal":{"name":"JACC. Case reports","volume":"30 31","pages":"Article 105321"},"PeriodicalIF":0.0,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145242207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Coronary Microvascular Dysfunction Related to Hydroxychloroquine-Induced Cardiomyopathy 冠状动脉微血管功能障碍与羟氯喹引起的心肌病有关

JACC. Case reports Pub Date : 2025-10-08 DOI: 10.1016/j.jaccas.2025.105337

Donald Richards MD, MPH, Deeksha Acharya MD, Serguei Bannykh MD, Louise Thomson MD, Evan Kransdorf MD, PhD, Noel Bairey Merz MD

{"title":"Coronary Microvascular Dysfunction Related to Hydroxychloroquine-Induced Cardiomyopathy","authors":"Donald Richards MD, MPH, Deeksha Acharya MD, Serguei Bannykh MD, Louise Thomson MD, Evan Kransdorf MD, PhD, Noel Bairey Merz MD","doi":"10.1016/j.jaccas.2025.105337","DOIUrl":"10.1016/j.jaccas.2025.105337","url":null,"abstract":"<div><h3>Background</h3><div>A 69-year-old woman with seropositive rheumatoid arthritis presented with subacute worsening of her chronic chest pain.</div></div><div><h3>Case Summary</h3><div>Cardiac magnetic resonance demonstrated new diffuse edema, patchy late gadolinium enhancement, and a reduction in myocardial perfusion reserve index, which raised concern for an infiltrative cardiomyopathy leading to microvascular dysfunction. An endomyocardial biopsy resulted in a rare diagnosis of drug-induced cardiomyopathy.</div></div><div><h3>Discussion</h3><div>We report a new association between this drug toxicity and coronary microvascular disease. This represents not only a new finding but potential expanded understanding of the pathophysiology of this disease condition. This finding could have implications for both diagnostic testing and disease management.</div></div><div><h3>Take-Home Messages</h3><div>This case establishes a new relationship between hydroxychloroquine cardiomyopathy and microvascular dysfunction. In addition to the cytotoxic effects of hydroxychloroquine, there may be an additional mechanism of vascular injury leading to the known manifestations with various electrical disturbances, and myocardial dysfunction.</div></div>","PeriodicalId":14792,"journal":{"name":"JACC. Case reports","volume":"30 31","pages":"Article 105337"},"PeriodicalIF":0.0,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145242210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Noncardiac Procedural Complication Resulting in Pericarditis 引起心包炎的非心脏手术并发症

JACC. Case reports Pub Date : 2025-10-08 DOI: 10.1016/j.jaccas.2025.105338

Grace Hagan MD , Teodora Donisan MD , Hayan Jouni MD , Sushil A. Luis MD

{"title":"Noncardiac Procedural Complication Resulting in Pericarditis","authors":"Grace Hagan MD , Teodora Donisan MD , Hayan Jouni MD , Sushil A. Luis MD","doi":"10.1016/j.jaccas.2025.105338","DOIUrl":"10.1016/j.jaccas.2025.105338","url":null,"abstract":"<div><h3>Background</h3><div>Endoscopic cyanoacrylate injection (ECI) is a standard management for bleeding gastric varices. There have been no previous cases of pericarditis secondary to ECI into the pericardium.</div></div><div><h3>Case Summary</h3><div>A 55-year-old woman with bleeding gastric varices secondary to pancreatic neuroendocrine tumor with splenic vein involvement underwent ECI, which resulted in postprocedural pericarditis secondary to direct injection into the pericardial space.</div></div><div><h3>Discussion</h3><div>Management of this foreign substance–induced pericarditis is outside the realm of current guidelines. Based on the known inflammatory and insoluble nature of cyanoacrylate, standard anti-inflammatory therapies were implemented. Despite prolonged anti-inflammatory therapy, this patient continues to have symptomatic pericarditis as well as inflammatory changes on cardiac imaging months after her procedure.</div></div><div><h3>Take-Home Messages</h3><div>Postprocedural pericarditis from ECI is an infrequent yet serious complication. It is imperative to monitor serial inflammatory markers and cardiac imaging, as well as to monitor symptom resolution, to assess the need for prolonged anti-inflammatory tapers or pericardiectomy.</div></div>","PeriodicalId":14792,"journal":{"name":"JACC. Case reports","volume":"30 31","pages":"Article 105338"},"PeriodicalIF":0.0,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145242214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Ultrasound-Facilitated, Catheter-Directed Thrombolysis to Treat Transcatheter Pulmonary Valve Frame Thrombosis 超声引导导管溶栓治疗经导管肺动脉瓣框架血栓形成

JACC. Case reports Pub Date : 2025-10-08 DOI: 10.1016/j.jaccas.2025.105322

Thomas M. Das MD, Margaret Fuchs MD, Joanna Ghobrial MD, MSc

{"title":"Ultrasound-Facilitated, Catheter-Directed Thrombolysis to Treat Transcatheter Pulmonary Valve Frame Thrombosis","authors":"Thomas M. Das MD, Margaret Fuchs MD, Joanna Ghobrial MD, MSc","doi":"10.1016/j.jaccas.2025.105322","DOIUrl":"10.1016/j.jaccas.2025.105322","url":null,"abstract":"<div><h3>Objective</h3><div>We present a patient with tetralogy of Fallot who underwent transcatheter pulmonary valve replacement complicated by elevated pulmonary valve gradients and subvalvular mural thrombus, and was treated using ultrasound-facilitated, catheter-directed thrombolysis.</div></div><div><h3>Key Steps</h3><div>Right internal jugular access was obtained, and the EKOS endovascular system was advanced across the pulmonary valve and used to deliver slow infusions of alteplase. We then performed balloon valvuloplasty of the transcatheter pulmonary valve after 48 hours of lysis.</div></div><div><h3>Potential Pitfalls</h3><div>There is risk for intracranial hemorrhage while receiving prolonged infusions of intravascular lytic therapy; the patient was monitored in the intensive care unit with frequent neurologic examinations and serum coagulation tests.</div></div><div><h3>Take-Home Messages</h3><div>Valve thrombosis is a known complication of transcatheter pulmonary valve replacement, the management of which typically involves either percutaneous valve-in-valve implantation or surgical valve replacement. The novel approach detailed in this report presents an alternative that avoids sternotomy or implanting a second transcatheter valve.</div></div>","PeriodicalId":14792,"journal":{"name":"JACC. Case reports","volume":"30 31","pages":"Article 105322"},"PeriodicalIF":0.0,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145242261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Early Recognition of Giant Cell Myocarditis in a Patient With Fascicular Ventricular Tachycardia 束状室性心动过速患者巨细胞心肌炎的早期识别

JACC. Case reports Pub Date : 2025-10-08 DOI: 10.1016/j.jaccas.2025.105333

Alexander C. Sacher DO , Rafsan Ahmed MD , Andrew Kung MD , Krishnadev Pillai MD , Jasneel Kahlam DO

{"title":"Early Recognition of Giant Cell Myocarditis in a Patient With Fascicular Ventricular Tachycardia","authors":"Alexander C. Sacher DO , Rafsan Ahmed MD , Andrew Kung MD , Krishnadev Pillai MD , Jasneel Kahlam DO","doi":"10.1016/j.jaccas.2025.105333","DOIUrl":"10.1016/j.jaccas.2025.105333","url":null,"abstract":"<div><h3>Background</h3><div>Giant cell myocarditis (GCM) is a rare, rapidly progressive inflammatory cardiomyopathy, often manifesting with ventricular arrhythmias or heart failure. Early recognition and immunosuppressive therapy are crucial for improving outcomes.</div></div><div><h3>Case Summary</h3><div>A 65-year-old man undergoing preoperative evaluation for hip surgery was found to have a wide complex tachycardia. He reported palpitations and dizziness but denied chest pain. Troponin was significantly elevated (5,206 ng/L, peaking at 5,647 ng/L). Transthoracic echocardiography showed reduced left ventricular ejection fraction (35%-40%), and cardiac magnetic resonance suggested myocarditis. Endomyocardial biopsy confirmed GCM. The patient was started on pulse-dose steroids, tacrolimus, and mycophenolate mofetil, resulting in swift improvement as indicated by rapidly downtrending troponin levels. He was ultimately listed for heart transplantation.</div></div><div><h3>Discussion</h3><div>GCM often manifests with ventricular arrhythmias and rapid clinical deterioration. This case underscores the importance of recognizing myocarditis as a cause of ventricular tachycardia, particularly in patients with elevated troponins and nonobstructive coronary artery disease. Early diagnosis and immunosuppression are key to improving prognosis.</div></div><div><h3>Take-Home Messages</h3><div>Consider myocarditis in patients with ventricular tachycardia and high troponins and nonobstructive coronary artery disease. Early recognition and immunosuppressive therapy are critical for management of GCM. Cardiac magnetic resonance and biopsy are essential for diagnosis. Orthotopic heart transplantation should be considered in all cases of GCM owing to the associated high mortality rates.</div></div>","PeriodicalId":14792,"journal":{"name":"JACC. Case reports","volume":"30 31","pages":"Article 105333"},"PeriodicalIF":0.0,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145242208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0