[Rare cause of tachy-, asl well asl bradycardic arrhythmias].
A 53-year-old female patient from the Philippines was admitted with intermittent complete heart block and assumed coronary artery disease. Physical examination was normal except for moist pulmonary sounds. ECG and monitoring showed bifascicular block and polymorphic ventricular tachycardia. A markedly reduced left ventricular function was seen in the echocardiogram. Coronary angiography showed two vessel disease. Endomyocardial biopsy revealed florid giant cell myocarditis. Heart failure and ventricular arrhythmias were ameliorated under immunosuppressive triple-therapy (corticosteroid, cyclosporin A, and azathioprine). Four weeks later, the patient received a cardiac transplant without complications. Two months later, a clinically inapparent cardiac rejection was diagnosed by endomyocardial biopsy, which was treated by corticoid pulse therapy and antithymocyteglobulin. Four weeks later, pneumocystis carinii pneumonia and cytomegaly virus exacerbation were diagnosed and successfully treated. Idiopathic giant cell myocarditis is a rare disease with progressive congestive heart failure and ventricular arrhythmias or complete heart block often accompanied by syncope or sudden death. Associations with autoimmune diseases have been reported. Giant cell myocarditis is diagnosed by endomyocardial biopsy or at autopsy. Treatment is difficult and comprises immunosuppressive agents (triple-therapy) and cardiac transplantation. Recurrence of giant cell myocarditis in cardiac transplants has been described. Without immunosuppressive treatment the median survival is three months.
Kohl
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Medizinische Klinik I (Abteilung Kardiologie und Angiologie) der Justus-Liebig-Universität Giessen Klinikstrasse 36 D-35392 Giessen.
Bohle
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RM
Voss
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D001706:Biopsy; D001919:Bradycardia / Q000209:etiology* / Q000473:pathology; D003937:Diagnosis, Differential; D004699:Endocardium / Q000473:pathology; D005260:Female; D015726:Giant Cells / Q000473:pathology; D006084:Graft Rejection / Q000175:diagnosis / Q000473:pathology; D006327:Heart Block / Q000209:etiology*; D016027:Heart Transplantation / Q000473:pathology; D006801:Humans; D008875:Middle Aged; D009205:Myocarditis / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D009206:Myocardium / Q000473:pathology; D012008:Recurrence; D013610:Tachycardia / Q000209:etiology* / Q000473:pathology