case_images: PMC9068965_01
case_images: Serial in-hospital ECGs on 8/11 (A) from other hospital, 8/13 (B), and 8/24 (C).
case_images: fcvm-09-856991-g001.jpg
case_images: PMC9068965_01_fcvm-09-856991-g001.jpg
case_images: F1
case_images: ECG showed diffuse low QRS voltage and 1 mm convex ST elevation over V1 and V2 (Figure 1A). ECG showed sinus tachycardia, diffuse low QRS voltage, and convex ST elevation over V1 to V3 (Figure 1B). On August 23, her LVEF was 45% by echocardiography and ECG showed evolutionary changes including higher QRS voltage and diffuse T wave inversion (Figure 1C).
case_images: Cardiac MRI of the patient. (A) Cardiac MR 4-chamber cine end-systolic (left) and end-diastolic (right) images show the limited LV dimensional change, indicative of the impaired LV systolic function. (B) Cardiac MR late Gadolinium enhancement images of short-axis (left, middle) and 4-chamber (right) view. Yellow arrows depict the patchy enhancements sparsely distributed in the mid-layer and subepicardium in a non-ischemic pattern, arrowheads depict pericardial enhancement and stars depict pericardial effusion. The curved dashed line depicts the subendocardial enhancement in the antero-septal subendocardium of LV mid-cavity which is within the LAD territory. (C) T1 map (left), ECV map (middle) and T2 map (right) in short-axis views show elevated T1, ECV, and T2 values, indicating acute myocardial injury (global T1 = 1,583 ms, ECV = 48%, T2 = 77 ms; institution-specific cut-off values for abnormal myocardium: T1 global >= 1,250 ms, T2 global >= 60 ms). CMR findings meet updated 2018 Lake Louise criteria for acute myocarditis. The curved dashed lines depict the focally elevated T1 and ECV values in the antero-septal subendocardium, equivalent to the enhanced area depicted in (B).
case_images: fcvm-09-856991-g002.jpg
case_images: PMC9068965_01_fcvm-09-856991-g002.jpg
case_images: F2
case_images: LV hypokinesia with LVEF 41.6% and markedly increased LV T1 and T2 signal values (Figure 2). Late Gadolinium enhancement (LGE) images depict the patchy enhancements sparsely distributed in the mid-layer and subepicardium, and subendocardial enhancement in the antero-septal subendocardium of LV mid-cavity.