Figure 8. Acute and chronic myocarditis.

Panels A and B: 29-year-old who presented with acute myocarditis with peak troponin-I 72 ng/mL; peak creatine phosphokinase 2742 U/L, CK-MB 331μg/L. LVEF was mildly reduced (Video 1) but he was asymptomatic from the arrhythmia and HF standpoint during a 6 day hospitalization. Panel A: mid-septal and lateral epicardial wall LGE (arrows) and pericardial enhancement. Panel B: T2 weighted edema imaging with extensive edema (arrowheads). He died suddenly at home 2 days post-discharge.

Panel C: 22 year-old with documented acute myocarditis 15 months previously. CMR-LGE showed LGE of the distal segments of the LV with endocardial sparing (arrows) and pericardium. LV function was normal with no regional wall motion abnormalities (Video 2). Two years later, the patient developed palpitations and syncope with large burden of multifocal PVCs on Holter (>5%). EPS showed easily inducible monomorphic and polymorphic VT. An ICD was implanted and subsequently fired multiple times for MVT at 250 beats per minute.