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Fulminant myocarditis presenting as cardiogenic shock — RCPSC EM MCQ

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HardCardiovascular emergenciesFulminant myocarditis presenting as cardiogenic shockRCPSC EM

CTAS 1: A 19-year-old has chest pain and dyspnoea one week after viral symptoms. Vitals are BP 78/44, HR 132, SpO2 90%. ECG shows diffuse ST changes, troponin is markedly elevated and POCUS shows severely reduced biventricular function without pericardial effusion. What is the most likely diagnosis?

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Correct answer: C — Fulminant myocarditis

Shock, high troponin and global ventricular dysfunction after viral prodrome suggest fulminant myocarditis. Management requires inotropes or vasopressors, ICU and mechanical circulatory support consideration.

Reference: Canadian cardiovascular emergency practice; myocarditis consensus guidance