Cardiomyopathies

Case Synopsis

A 3-year-old boy presents for inguinal hernia repair. His past medical history is unremarkable except for an upper respiratory infection 3 weeks ago that was characterized by a low-grade fever, thin rhinorrhea, and a mild cough that resolved last week. His physical examination and vital signs are normal. On anesthetic induction with nitrous oxide, oxygen, and sevoflurane his heart rate increases to 180 beats per minute, the electrocardiogram (ECG) QRS complex is noted to be wide, the pulse oximeter plethysmograph flattens, and no femoral pulse can be palpated. Full cardiopulmonary resuscitation is performed but proves unsuccessful. Autopsy reveals a dilated left ventricle and evidence of myocardial inflammation consistent with viral myocarditis.