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AAA Intervention Threshold — EECC MCQ

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HardAortic DiseaseAAA Intervention ThresholdEECC

A patient with rapidly progressive heart failure, ventricular arrhythmias and complete heart block deteriorates despite standard therapy. CMR is compatible with myocarditis. Which investigation is most important because giant-cell myocarditis is suspected?

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Correct answer: E — Perform urgent endomyocardial biopsy with viral studies and immune-histological tissue analysis

Rapidly progressive heart failure with ventricular arrhythmia and complete heart block is a high-risk myocarditis phenotype in which urgent endomyocardial biopsy can identify giant-cell myocarditis and change immunosuppressive and mechanical-support decisions. Repeat cardiovascular magnetic resonance after three months is too slow to provide tissue. Outpatient genetic testing cannot diagnose active giant-cell inflammation, coronary calcium scoring does not assess myocardial histology, and exercise testing is unsafe and non-diagnostic during this deterioration.

Reference: 2025 ESC Guidelines for myocarditis and pericarditis. https://academic.oup.com/eurheartj/article/46/40/3952/8234483