FDG-PET as a New Protagonist in the Evaluation of Myocarditis: A Case Report

Authors

DOI:

https://doi.org/10.36557/pbpc.v3i2.226

Keywords:

Myocarditis, PET Scan, Ventricular tachycardia, case report

Abstract

Myocarditis occurs when the myocardium becomes inflamed. Clinical manifestations can be subtle, and diagnosis remains challenging for cardiologists, requiring high suspicion and advanced multimodal cardiac imaging to avoid life-threatening consequences. In this case, we demonstrate a 17-year-old male patient with no personal or family history of heart disease who presents with episodic palpitations after intense exercise and a sudden syncopal event at rest associated with a heart rate (HR) of 142 bpm and tracing suggestive of monomorphic ventricular tachycardia (VT), recorded with a Smart Watch. Given the suspicion of idiopathic myocarditis, a PET Scan was ordered, showing an uptake pattern suggestive of myocarditis. The patient received metoprolol succinate 25 mg, prednisone 60 mg, empagliflozin 12.5 mg, and ramipril 10 mg, improving the symptoms. This report aims to briefly overview PET Scan as a noninvasive tool for assessing and diagnosing myocarditis, enabling faster and targeted clinical management.

References

Caforio AL, Pankuweit S, Arbustini E, Basso C, Gimeno-Blanes J, Felix S B, Fu M, Hellô T, Heymans S, Jahns R, Klingel K, Linhart A, Maisch B, Mckenna W, Mogensen J, Pinto Y M, et al. Current state of knowledge on etiology, diagnosis, management, and therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J. 2013;34(33):2636-48. doi:10.1093/eurheartj/eht210

Tschöpe, C., Ammirati, E., Bozkurt, B, Caforio A L P, Cooper L T, Felix S B, Hare J M, Heidecker B, Heymans S, Hubner N, Kelle S, Klingel K, Maatz H, Parwani A, Spillman F, et al. Myocarditis and inflammatory cardiomyopathy: current evidence and future directions. Nat Rev Cardiol 18, 169–93 (2021). https://doi.org/10.1038/s41569-020-00435-x

Cooper LT Jr. Myocarditis. N Engl J Med. 2009;360(15):1526-1538. doi:10.1056/NEJMra0800028

Ammirati E, Frigerio M, Adler ED, Basso C, Birnie D H, Brambatti M, Friedrich M G, Klingel K, Lehtonen J, Moslehi J J, Pedrotti P, Rimoldi O E, Schultheiss H P, Tschope C, Cooper Jr L T, et al. Management of Acute Myocarditis and Chronic Inflammatory Cardiomyopathy: An Expert Consensus Document. Circ Heart Fail. 2020;13(11):e007405. doi:10.1161/CIRCHEARTFAILURE.120.007405

Chen, W., Jeudy, J. Assessment of Myocarditis: Cardiac MR, PET/CT, or PET/MR?. Curr Cardiol Rep 21, 76 (2019). https://doi.org/10.1007/s11886-019-1158-0

Luetkens JA, Faron A, Isaak A, Dabir D, Kuetting D, Feisst A, Schmeel F C, Sprinkart A M, Thomas D. Comparison of Original and 2018 Lake Louise Criteria for Diagnosis of Acute Myocarditis: Results of a Validation Cohort. Radiol Cardiothoracic Imaging. 2019;1(3):e190010. Published 2019 Jul 25. doi:10.1148/ryct.2019190010

Bami K, Haddad T, Dick A, Dennie C, Dwivedi G. Noninvasive imaging in acute myocarditis. Curr Opin Cardiol. 2016;31(2):217-23. doi:10.1097/HCO.0000000000000265

Abdel-Aty H, Boyé P, Zagrosek A, Wassmuth R, Kumar A, Messroghli D, Bock P, Dietz E, Friedrich M G, Schulz-Menger J. Diagnostic performance of cardiovascular magnetic resonance in patients with suspected acute myocarditis: comparison of different approaches. J Am Coll Cardiol. 2005;45(11):1815-22. doi:10.1016/j.jacc.2004.11.069

Nensa F, Kloth J, Tezgah E, Poeppel T D, Heusch P, Goebel J, Nassenstein K, Schlosser T. Feasibility of FDG-PET in myocarditis: Comparison to CMR using integrated PET/MRI. J Nucl Cardiol. 2018;25(3):785-94. doi:10.1007/s12350-016-0616-y

James OG, Christensen JD, Wong TZ, Borges-Neto S, Koweek LM. Utility of FDG PET/CT in inflammatory cardiovascular disease. Radiographics. 2011:1271–86. doi: 10.1148/rg.315105222. 31(5)PMID: 21918044.

Published

2024-09-03

Issue

Section

Ciências da Saúde