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Tubercular myocarditis presenting with ventricular tachycardia

Nature Clinical Practice Cardiovascular Medicine volume 5, pages 169–174 (2008)Cite this article

Abstract

Background A previously fit and healthy 30-year-old man reported experiencing palpitations accompanied by nausea, sweating and presyncope. These symptoms were found to be associated with episodes of nonsustained ventricular tachycardia. He was a nonsmoker, did not drink excessively, denied illicit drug use and had no family history of structural cardiac disease or sudden death.

Investigations Electrocardiography, laboratory tests, electrophysiological studies, echocardiography, coronary angiography, chest radiography, cardiac MRI (with late gadolinium enhancement), chest CT, lymph-node biopsy, Ziehl Nielsen staining, blood and sputum cultures and heaf testing.

Diagnosis Tubercular myocarditis.

Management Antituberculous chemotherapy supported by antiarrhythmic and steroid pharmacotherapy and cardioverter-defibrillator implantation. Repeated imaging was performed to monitor disease progression.

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Figure 1: Electrocardiogram recorded from the patient shortly after presentation demonstrating ventricular tachycardia with right bundle branch block morphology.
Figure 2: Serial late gadolinium-enhanced cardiac MRI scans of the patient with tubercular myocarditis.
Figure 3: Thoracic CT images from the patient.
Figure 4: Serial late gadolinium enhancement cardiac MRI scans from a second patient with tubercular myocarditis, showing resolution of myocardial edema but the persistence of fibrosis (R Khurana, unpublished data).
Figure 5: Histological specimen with hematoxylin and eosin staining, taken from a biopsy of the enlarged left axillary lymph node of the second patient (R Khurana, unpublished data).

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Author information

Authors and Affiliations

  1. JS Kooner is a Professor and Consultant and A Sethi is a Consultant at the Department of Cardiology, R Khurana is a Specialist Registrar, J Shalhoub and A Verma are Senior House Officers, Ealing Hospital NHS Trust, Southall, and R Assomull is a Research Fellow and SK Prasad is a Consultant at the Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK.,

    Rohit Khurana, Joseph Shalhoub, Anju Verma, Ravi Assomull, Sanjay K Prasad, Jaspal S Kooner & Amarjit Sethi

Authors
  1. Rohit Khurana
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  2. Joseph Shalhoub
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  3. Anju Verma
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  4. Ravi Assomull
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  5. Sanjay K Prasad
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  6. Jaspal S Kooner
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  7. Amarjit Sethi
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Corresponding author

Correspondence to Rohit Khurana.

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The authors declare no competing financial interests.

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Khurana, R., Shalhoub, J., Verma, A. et al. Tubercular myocarditis presenting with ventricular tachycardia. Nat Rev Cardiol 5, 169–174 (2008). https://doi.org/10.1038/ncpcardio1111

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