Postural hypotension as the initial presentation of fulminant right ventricular myocarditis

Cheng Hsuan Ho, Ya Chieh Wu, Yen Yue Lin, Chin Wang Hsu, Shih Hung Tsai

Research output: Contribution to journalArticle

4 Citations (Scopus)


Myocarditis can be totally asymptomatic or can manifest with chest pain syndromes, ranging from mild persistent chest pain of acute myopericarditis to severe symptoms that mimic acute myocardial infarction. About 60% of patients may have antecedent arthralgias, malaise, fevers, sweats, or chills consistent with viral infections 1 to 2 weeks before onset. Here, we report a postpartum young woman who developed postural hypotension as the first manifestation of fulminant myocarditis with initially acute "cold and dry" right-sided heart failure and cardiogenic shock. Common causes of postural hypotension include volume depletion, medications, diabetes, alcohol, infection, and varicose veins as well as dysautonomic syndromes. Fulminant myocarditis can cause cardiogenic shock. Myocardial inflammation more frequently affects localized areas of the left ventricle free wall, rarely right ventricle (RV). However, predominant RV involvement with acute right-sided heart failure and low cardiac output syndrome can be easily overlooked due to lack of typical heart failure signs. On reviewing medical literatures, we had found no report regarding the RV involvement with acute right-sided heart failure as the initial presentation of fulminant myocarditis.

Original languageEnglish
Pages (from-to)708-710
Number of pages3
JournalAmerican Journal of Emergency Medicine
Issue number6
Publication statusPublished - Jul 2010
Externally publishedYes


ASJC Scopus subject areas

  • Emergency Medicine
  • Medicine(all)

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