Difficulties in diagnosing acute myocarditis by the example of a patient with decompensated chronic heart failure

Abstract

Background. Myocarditis is defined as myocardial inflammation that can progress to inflammatory cardiomyopathy with concomitant cardiac remodeling and dysfunction due to chronic inflammation. Myocarditis can present with many different symptoms and often mimics other common heart diseases. Thus, it is often difficult to diagnose myocarditis based on clinical symptoms. However, it is important to get diagnosed as early as possible as treatment varies greatly and can significantly improve outcomes and prevent the disease from progressing to dilated cardiomyopathy or heart failure. The purpose of the study is to consider, using a clinical case as an example, the features of management and clinical hypotheses of the causes of decompensation of heart failure. Materials and methods. A clinical example of a favorable outcome of acute myocarditis with the development of severe heart failure in a patient with erroneously diagnosed dilated cardiomyopathy is given. Based on the information available at the present stage of development of medical science, the reasons for incorrect diagnosis are considered, the possibilities of verifying the correct diagnosis, treatment tactics and prospects for improving the diagnosis and treatment of such patients are discussed. Results. This clinical case demonstrates the high effectiveness of conservative therapy for CHF, its almost complete regression in a relatively short period. Diagnostic hypotheses about the presence of dilated cardiomyopathy (presumably of toxic-alimentary origin) and PICS n/a in the patient do not seem to be valid, since even the use of the most comprehensive therapy for CHF in a short period (3 months of therapy) cannot lead to restoration of LV systolic function, probable disappearance zones of hypokinesia and akinesia, as well as to significant clinical regression of symptoms and the patient’s return to their usual lifestyle. Conclusions. Taking into account the above analysis, it seems to us that the development and decompensation of CHF in this patient was based on acute infectious myocarditis, as a complication of severe bilateral polysegmental pneumonia suffered by the patient.

Keywords

• acute myocarditis
• severe heart failure
• dilated cardiomyopathy