Fulminant Eosinophilic Myocarditis and VT Storm

Figure 1. Electrocardiogram at Presentation Sinus tachycardia at a rate of 113 beats/min with frequent polymorphic PVCs. A sinus beat (gray arrow) and 2 different PVC morphologies (black and white arrows), both likely originating from the posterobasal or posteromedial left ventricle, are highlighted (10).

Figure 2. Transthoracic Echocardiogram (A) End-diastolic and (B) end-systolic frames of the parasternal long-axis view. Left and right ventricular function and wall thickness were normal, with left ventricular basal anteroseptal hypokinesis.

Figure 3. Polar Plot of Peak Longitudinal Strain Speckle-tracking peak global longitudinal strain of the left ventricle is reduced at -11% with an exaggerated apical sparing pattern. ANT = anterior; INF = inferior; LAT = lateral; POST = posterior; SEPT = septal.

Figure 4. Rhythm Strip Rhythm strip before cardiac arrest with R-on-T phenomenon (black arrow) triggering ventricular tachycardia.

Figure 5. Autopsy Histopathology (Hematoxylin and Eosin) Cardiac myocytes with interstitial inflammatory infiltrate composed of numerous eosinophils (black arrow) and occasional mast cells throughout the left and right ventricular myocardium, consistent with eosinophilic myocarditis with minimal necrosis.