Open AccessAcute myocarditis complicated with permanent complete atrioventricular block caused by Escherichia coli bacteremia
Author(s) -
ChingTsai Hsu,
Po-Jen Hsiao,
Shin-Huei Liu,
YuCheng Chou,
Bo-Hau Chen,
Jun-Ting Liou
Publication year - 2019
Publication title -
medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.59
H-Index - 148
eISSN - 1536-5964
pISSN - 0025-7974
DOI - 10.1097/md.0000000000017833
Subject(s) - medicine , myocarditis , atrioventricular block , cardiology , chest pain , asymptomatic , heart block , myocardial infarction , sepsis , surgery , electrocardiography
Rationale: Acute myocarditis complicated with complete atrioventricular block (CAVB) is rare in clinical scenario. We report an uncommon case of myocarditis complicated with permanent CAVB caused by Escherichia coli ( E coli ) bacteremia. Patient concerns: A 77-year-old woman presented at the emergency department with chest pain, dizziness, nausea, and cold sweats of 1-day duration. She had histories of type 2 diabetes mellitus, hyperlipidemia, and chronic kidney disease with regular medical therapy. Diagnosis: Both blood and urine cultures were positive for E coli . Regional inferior wall motion abnormalities on echocardiography, unexplained life-threatening arrhythmias, newly abnormal electrocardiogram, elevated cardiac troponins, and healthy coronary arteries on angiography were consistent with E coli -induced myocarditis. Interventions: The patient received implantation of a dual-chamber pacemaker because of irreversible CAVB. Outcomes: The patient was discharged on day 8 and remained asymptomatic at 15 months of follow-up, with ST-segment normalization and normal left ventricular function. Lessons: This extremely rare case of E coli-induced myocarditis masquerading as acute STEMI and with permanent CAVB sequelae, highlights the importance of sensitivity to non-ischemia etiologies of ST-segment elevation and the potential impact of E coli sepsis on the cardiac conduction system.