Myocarditis is inflammation of cardiac muscle, which may be acute, subacute, or chronic with either focal or diffuse involvement of the myocardium. This leads to a cardiomyopathy with clinical features of heart failure as well as echocardiographic evidence of global dilation of the cardiac chambers. There are numerous reports in the literature of viral myocarditis causing dilated cardiomyopathy; however, there are no reports of recurrent viral myocarditis and vaccine-associated myocarditis in a single patient with complete reversal of the cardiomyopathy and return to normal cardiac function. We present a case of recurrent myocarditis in a female patient caused by a viral upper respiratory infection and streptococcal pneumonia vaccination who presented with recurrent episodes of reversible cardiomyopathy.
Myocardial contrast echocardiography (MCE) has been used with increasing frequency and is considered a safe way to improve left ventricular border opacification. Studies have consistently documented that MCE can improve the ability to assess both global and regional left ventricular function by echocardiography. We report the case of an 83-year-old female who developed immediate and sustained hemodynamic instability after the injection of Perflutren for a contrast echocardiogram. We reviewed the literature and found no such previous reactions with Perflutren. Based on the temporal sequence of hypotension following Perflutren injection along with other clinical data, we concluded that our patient's hemodynamic instability was most likely secondary to an anaphylactic reaction.
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