case_images: PMC7992434_01
case_images: EKG showing heart block with complete atrioventricular dissociation, and idioventricular rhythm at 38 beats/minute
case_images: PAMJ-37-391-g001.jpg
case_images: PMC7992434_01_PAMJ-37-391-g001.jpg
case_images: F1
case_images: The electrocardiogram (EKG) showed grade III atrioventricular (AV) bloc with a ventricular rate of 38 beats per minute (Figure 1).
case_images: reduced left ventricular longitudinal strain (LV GLS -14.1%) with marked alteration in the anteroseptal segments
case_images: PAMJ-37-391-g002.jpg
case_images: PMC7992434_01_PAMJ-37-391-g002.jpg
case_images: F2
case_images: The initial transthoracic echocardiography (TTE) showed a normal global left ventricular function (left ventricular ejection fraction (LVEF) 60%) and wall motion abnormalities (anteroseptal hypokinesia), with reduced left ventricular global longitudinal strain (LV GLS= -14.1%) (Figure 2).
case_images: A) cardiac magnetic resonance (CMR) showed increased signal intensity at the mid-lateral wall on T2-weighted images; late enhancement revealed a patchy subepicardial hyperenhancement of the medio-distal segments of the anterior and anterolateral walls (B and C)
case_images: PAMJ-37-391-g003.jpg
case_images: PMC7992434_01_PAMJ-37-391-g003.jpg
case_images: F3
case_images: Late enhancement revealed a patchy subepicardial hyperenhancement of the medio-distal segments of the anterior and anterolateral walls which confirm the diagnosis of myocarditis (Figure 3).
case_images: left ventricular longitudinal strain (LV GLS -19.3%) with mild alteration in the anterolateral segments
case_images: PAMJ-37-391-g004.jpg
case_images: PMC7992434_01_PAMJ-37-391-g004.jpg
case_images: F4
case_images: The TTE revealed a normal LVEF and an improvement in the left ventricular global longitudinal strain (LVGLS) with segmental reduced values concordant with the CMR abnormalities (Figure 4).