A 38-year-old woman presenting with cardiogenic shock and an LVEF of 16.4% was successfully managed with an Impella 5.5 and subsequent cardiac transplantation for giant cell myocarditis.
Case Report (n=1)
CMR demonstrating transmural enhancement should raise suspicion for infiltrative etiology like giant cell myocarditis, prompting early biopsy and intervention.
Abstract Background Giant Cell Myocarditis is a rapidly progressive, infiltrative myocardial disease commonly affecting younger populations. Given its rapid progression, mortality is high if not diagnosed and managed promptly. Standard management includes immunosuppression and heart transplantation. Case A 38-year-old woman with a past medical history significant for newly diagnosed heart failure presented with palpitations and dyspnea on exertion and was found to be in cardiogenic shock. Transthoracic echocardiogram showed a worsening left ventricular ejection fraction of 16.4%. A Cardiac Magnetic Resonance (CMR) study was performed which demonstrated severe left ventricular thinning and transmural scarring, raising concerns for cardiac sarcoidosis. An ischemic, autoimmune, and serologic workup was initiated, all of which were unrevealing. Her shock was treated with inotropes and vasopressor support; however, perfusion markers continued to worsen. An Impella 5.5 was placed, and the patient was transferred to a cardiac transplant center. The biopsy of the native heart performed after cardiac transplantation revealed giant cell myocarditis. Discussion In this case, we emphasize the importance of early intervention and the utility of CMR in the diagnosis of infiltrative cardiomyopathies, including giant cell myocarditis. CMR demonstrating transmural enhancement consistent with scarring should raise suspicion for an infiltrative etiology. These findings should prompt early additional diagnostic imaging with 18F-Fluorodeoxyglucose Positron Emission Tomography (18-FDG-PET) or an endomyocardial biopsy as confirmatory testing. Following confirmation of giant cell myocarditis, initiation of immunosuppressive therapy and consideration of heart transplantation should be rapidly initiated. This abstract is funded by: None
Velis et al. (2026) conducted a case report in Giant Cell Myocarditis (n=1). Impella 5.5 and cardiac transplantation was evaluated. A 38-year-old woman presenting with cardiogenic shock and an LVEF of 16.4% was successfully managed with an Impella 5.5 and subsequent cardiac transplantation for giant cell myocarditis.