Objectives
Background: Myocarditis commonly presents as a young male with flu-like symptoms and elevated ESR, characteristics which make it easily overlooked by an obstetrician. While current incidence is unknown, myocarditis is most commonly viral and has been implicated in sudden cardiac death in young adults at rates of 8.6-12%. In early pregnancy an acute process impacting cardiac output can cause significant clinical problems.
Methods
Case: A 21-year old female who presented for shortness of breath was tachycardic with elevated D dimer. She was incidentally found to be 5 weeks pregnant. Negative influenza testing, chest x ray, lower extremity doppler studies, and CT negative for pulmonary embolus but with lower lobe intralobular septal thickening and possible edema. Transvaginal ultrasound found gestational and yolk sacs and pelvic ascites. During admission the patient had worsened tachycardia with sustained heart rate of 140-150 bpm, EKG indicating right ventricular hypertrophy and incomplete right bundle branch block, new bilateral infiltrates and effusions on chest x ray, pulmonary hypertension on echocardiogram with right ventricular systolic pressure of 42 mmg Hg and low normal ejection fraction at 50%. Elevated troponins, creatine kinase, and brain natriuretic peptide were also found. Intensive care unit admission was needed for worsening clinical condition. Laboratories ruled out HIV, hepatitis, lupus and other autoimmune conditions, cytomegalovirus, Epstein Barr virus, Legionella and numerous respiratory viruses. Positive Mycoplasma IgM pointed toward Mycoplasma pneumonia with associated myocarditis and she improved with proper therapies. At 2 week followup cardiac function was stable with resolved pulmonary hypertension. Cardiac MRI was planned for postpartum, and the intrauterine pregnancy continued to develop.
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