A Stormy Heart

This Clinical Problem-Solving case discusses a 68-year-old woman with progressive palpitations, dyspnea, and chest pressure, ultimately diagnosed with giant-cell myocarditis after recurrent ventricular tachycardia storms and extensive cardiac imaging. Initial suspicion of idiopathic fascicular VT and cardiac sarcoidosis gave way to biopsy-confirmed giant-cell myocarditis. Multimodality imaging including cardiac MRI and FDG PET-CT revealed diffuse myocardial inflammation and late gadolinium enhancement. Treatment included radiofrequency ablation, stellate ganglion blocks, and aggressive multidrug immunosuppression. The patient achieved long-term arrhythmia control and clinical stability.

This Clinical Problem-Solving case discusses a 68-year-old woman with progressive palpitations, dyspnea, and chest pressure, ultimately diagnosed with giant-cell myocarditis after recurrent ventricular tachycardia storms and extensive cardiac imaging. Initial suspicion of idiopathic fascicular VT and cardiac sarcoidosis gave way to biopsy-confirmed giant-cell myocarditis. Multimodality imaging including cardiac MRI and FDG PET-CT revealed diffuse myocardial inflammation and late gadolinium enhancement. Treatment included radiofrequency ablation, stellate ganglion blocks, and aggressive multidrug immunosuppression. The patient achieved long-term arrhythmia control and clinical stability.