A Novel Case of Acquired Isolated Left Ventricular Non-compaction in a Primigravida: Revisiting the Diagnostic Criteria of Left Ventricular Non-compaction.

Left ventricular non-compaction (LVNC) is rare cardiomyopathy characterized by the presence of a two-layered myocardium with prominent trabeculations. It has high rates of mortality and morbidity. Clinical presentation could vary from asymptomatic patients to developing ventricular arrhythmias, thromboembolism, heart failure, and even sudden cardiac death. We present a 23-year-old primigravida with a childhood history of dilated cardiomyopathy secondary to post-viral myocarditis presenting at 32 weeks gestation with dyspnea on exertion. Initial 2-D echocardiogram revealed a mildly dilated left ventricle with apical trabeculation and a 2-layer distinction between compacted and noncompacted myocardium indicating non-compaction of the left ventricle. This case presents a peculiar confluence of cardiac genetics, normal physiology, and infection. We describe a rare form of acquired LVNC that transformed from another type of cardiomyopathy to LVNC during pregnancy drawing attention to the causality pathways of LVNC.

Acute myocarditis in bodybuilder from coxsackievirus and thyrotoxicosis.

A 25-year-old male with no past medical history presented with 1 day of chest pain. The patient had exercised with high intensity for a bodybuilding competition. He had fever, malaise, sore throat, and cough 1 week before presentation. He was tachycardic and tachypneic. Cardiac examination was unremarkable. Electrocardiogram showed diffuse ST segment elevation. Laboratory results showed leukocytosis, creatinine kinase 3078 unit/L, and troponin I 78.06 ng/mL. Coronary angiography revealed no occlusion. Echocardiogram showed ejection fraction of 45% with global hypokinesis. The next day, the patient became dyspneic, hypoxic, and hypotensive. Chest X-ray showed pulmonary edema requiring intubation for respiratory failure. Inotropic support and intra-aortic balloon pump were started. A viral panel was ordered and antibody titer of coxsackievirus B type 4 was ≥1:640. On obtaining further history, it was found that he took liothyronine 75 mcg daily for 3 weeks. Thyroid-stimulating hormone was 0.015 U/mL and free T3 was 4.4 ng/mL. Burch-Wartofsky score was 75. Methimazole and hydrocortisone were started. Cardiac magnetic resonance imaging showed diffuse myocardial inflammation and edema. There was multifocal dense epicardial and midmyocardial necrosis in all segments. The patient was discharged on metoprolol and enalapril. The patient was instructed to refrain from supplements. .