Electrical storm in the inflamed heart: ventricular tachycardia due to myocarditis

Characterization of arrhythmias, evaluation of cardiac biomarkers and their association with survival in calves suffering from foot-and-mouth disease

INTRODUCTION

Foot-and-mouth disease (FMD) causes mortality in calves due to myocarditis; however, the effects of FMD virus on cardiac arrhythmogenesis and Purkinje cells are unknown. Identifying diagnostic and prognostic markers in FMD-affected calves may be useful in disease management in the endemic countries.

MATERIALS AND METHODS

A total of 81 FMD-affected calves were prospectively monitored till death or recovery. Foot-and-mouth disease was diagnosed by serology and reverse transcriptase-polymerase chain reaction (RT-PCR). Electrocardiography was recorded and serum cardiac biomarkers were measured. Histopathological examination of the ventricular myocardium was carried out in the calves that died of FMD (n = 33). Apparently healthy calves (n = 15) served as control.

RESULTS

Serology and RT-PCR consistently revealed that the FMD was caused by serotype O virus. Arrhythmias occurred in 62 of 81 (76.5%) FMD-affected calves, of which, ventricular premature complexes (VPCs) were the most common type (22%). The combined mortality rate due to ventricular tachycardia, polymorphic VPCs, and atrial fibrillation was 27.6%. Receiver operating characteristic curve analysis revealed that cardiac troponin I (cTnI) concentrations of ≥1.3 ng/mL were diagnostic of myocarditis with a sensitivity and specificity of 90% and 100%, respectively. Similarly, serum cTnI concentrations of <6.4 ng/mL were a good predictor of survival [odds ratio of 263; 95% confidence interval: 29-2371]. Histopathology of the myocardium revealed hyaline degeneration, necrosis, edema, mononuclear cell infiltration, and disruption by fibroblasts. Atrophy of the Purkinje cells was also present.

CONCLUSIONS

FMD induces cardiac arrhythmias and Purkinje cell pathology in the calf. Portable ECG coupled with assay of serum cTnI would help in predicting survival in FMD-affected calves.

Ventricular arrhythmia as an initial sign in acute Kawasaki disease: A case report

RATIONALE

Coronary artery lesion is the most prominent cardiac manifestation in Kawasaki disease. However, few cases of life-threatening cardiac arrhythmia were reported in the acute phase of Kawasaki disease.

PATIENT CONCERNS

A 1-year-old girl presented in the hospital with ventricular premature beats and ventricular tachycardia after 2 days of fever.

DIAGNOSIS

On the fifth day of fever, the diagnosis of Kawasaki disease was achieved.

INTERVENTIONS

Immunoglobulin was administered.

OUTCOME

The temperature became normal and ventricular arrhythmia disappeared.

LESSONS

This case suggests that Kawasaki disease has various clinical manifestations besides typical features, and it can cause life-threatening cardiac arrhythmia in the acute phase with normal coronary artery and normal cardiac function.