Interdisciplinary Approach to an Unusual Case of Myocarditis in PregnancyNovel Teaching Points
Aude Marceau, MD,
Justin M. McGinnis, MD,
Fatemeh Derakhshan, MD,
Yi Ariel Liu, MD,
Gnalini Sathananthan, MBBS, BSc,
Ana Clara Sosa Cazales, MD,
Jasmine Grewal, BSc, MD,
Andrew Ignaszewski, MD,
Elisabet Joa, MD,
Michael Luong, MD,
Mustafa Toma, MD, MSc,
Sean A. Virani, MD, MSc, MPH,
Michael A. Seidman, MD, PhD
Affiliations
Aude Marceau, MD
Department of Medicine, Division of Cardiology, Providence Health Care/University of British Columbia, Vancouver, British Columbia, Canada
Justin M. McGinnis, MD
Department of Obstetrics and Gynaecology, Providence Health Care/University of British Columbia, Vancouver, British Columbia, Canada
Fatemeh Derakhshan, MD
Department of Pathology and Laboratory Medicine, Providence Health Care/University of British Columbia, Vancouver, British Columbia, Canada
Yi Ariel Liu, MD
Department of Pathology and Laboratory Medicine, Providence Health Care/University of British Columbia, Vancouver, British Columbia, Canada
Gnalini Sathananthan, MBBS, BSc
Department of Medicine, Division of Cardiology, Providence Health Care/University of British Columbia, Vancouver, British Columbia, Canada
Ana Clara Sosa Cazales, MD
Department of Obstetrics and Gynaecology, Providence Health Care/University of British Columbia, Vancouver, British Columbia, Canada
Jasmine Grewal, BSc, MD
Department of Medicine, Division of Cardiology, Providence Health Care/University of British Columbia, Vancouver, British Columbia, Canada
Andrew Ignaszewski, MD
Department of Medicine, Division of Cardiology, Providence Health Care/University of British Columbia, Vancouver, British Columbia, Canada
Elisabet Joa, MD
Department of Obstetrics and Gynaecology, Providence Health Care/University of British Columbia, Vancouver, British Columbia, Canada
Michael Luong, MD
Department of Medicine, Division of Cardiology, Providence Health Care/University of British Columbia, Vancouver, British Columbia, Canada
Mustafa Toma, MD, MSc
Department of Medicine, Division of Cardiology, Providence Health Care/University of British Columbia, Vancouver, British Columbia, Canada
Sean A. Virani, MD, MSc, MPH
Department of Medicine, Division of Cardiology, Providence Health Care/University of British Columbia, Vancouver, British Columbia, Canada
Michael A. Seidman, MD, PhD
Department of Medicine, Division of Cardiology, Providence Health Care/University of British Columbia, Vancouver, British Columbia, Canada; Department of Pathology and Laboratory Medicine, Providence Health Care/University of British Columbia, Vancouver, British Columbia, Canada; Corresponding author: Dr Michael A. Seidman, Department of Pathology and Laboratory Medicine, 1081 Burrard St, Vancouver V6Z 1Y6, British Columbia, Canada. Tel.: +1-604-682-2344 ×64817; fax: +1-604-806-8158.
We present a case of myocarditis in a 26-year-old pregnant woman at 29 weeks gestation. Despite optimal medical therapy, she experienced a cardiac arrest 10 days postadmission. An interdisciplinary team facilitated emergency delivery of her baby by perimortem (ie, during maternal cardiac arrest) Caesarean section and initiation of emergency mechanical circulatory support. A cardiac biopsy revealed a mixed eosinophilic and histiocytic infiltrate. After a course of steroid therapy, she experienced full recovery. Both the patient and the infant are alive and well. The case highlights the success of modern interdisciplinary care, as well as ongoing gaps in our knowledge of myocarditis. Résumé: Nous présentons un cas de myocardite chez une femme de 26 ans enceinte de 29 semaines, qui a subi un arrêt cardiaque 10 jours après son admission. Une équipe interdisciplinaire a favorisé l'accouchement d'urgence par césarienne perimortem (c.-à-d. durant l'arrêt cardiaque de la mère), et la mise en place en urgence d'une assistance mécanique. Une biopsie cardiaque a révélé un infiltrat mixte d’éosinophiles et d'histiocytes. Il y a eu récupération complète de la fonction ventriculaire après un traitement aux stéroïdes. La patiente et l'enfant sont en vie et se portent bien. Le cas témoigne de la réussite de la pratique moderne des soins interdisciplinaires, et met en lumière les lacunes actuelles de nos connaissances sur la myocardite.
