A RARE AND INTERESTING PRESENTATION OF VIRAL MYOCARDITIS ASSOCIATED WITH HEART BLOCK

Abstract

According to the available literature myocarditis is usually mild to moderate. The condition is often unnoticed. This is due to the transient nature and the overriding                 symptom manifestation of the primary condition. We report an unusual presentation of myocarditis. A 4 year male child was brought to the emergency room with an episode suggestive of seizures. On Evaluation the cardiac monitor and ECG             revealed a complete heart block and asystole as the child developed a tonic posturing. The monitor showed regaining of the previous rhythm, as the child regained his sensorium. Investigations Cardiac Trop T and CK-MB were elevated. Viral assay was positive for coxsackie B virus.Discussion-In our patient the child presented in the ER with features                suggestive of a seizure disorder. This symptom was identified to be due to cardiac abnormality. The condition is reported because of the unusual presentation of myocarditis in the ER and heart block is a rare manifestation of infectious                    myocarditis. Thus a high suspicion is needed to diagnose mild to moderate myocarditis else this condition may have been mistreated as seizure disorder.