(131) Unraveling Coxsackie B, Acute Heart Failure, and Ventricular Non-Compaction in a Young Athlete

Introduction: Myocardial non-compaction (NC) is a rare cardiomyopathy that results from an early arrest of myocardium during fetal ontogenesis and is characterized by hypertrabeculations in the left or both ventricles. In this case report, we present a young athlete with biventricular NC presenting with acute heart failure secondary to Coxsackie B Virus (CBV).

Description: An 18-year-old man, previously healthy, arrived at the emergency department after suffering an out-of-hospital cardiac arrest while playing basketball. Paramedics, arriving 4 minutes later, identified ventricular fibrillation. After 6 minutes of resuscitation and one defibrillation, the patient achieved the return of spontaneous circulation to sinus rhythm. He was then intubated and transported to a nearby hospital. According to a family member, the patient complained of a cough and dyspnea for one week before presentation.

Upon admission, blood pressure was 168/74 mmHg, heart rate of 96 beats/min, and respiratory rate of 18 breaths/min with 40% inspired oxygen through an endotracheal tube. Electrocardiogram exhibited normal sinus rhythm. Despite an initial troponin of < 0.012 ng/mL, troponin levels were monitored every 3 hours, peaking at 4.090 ng/mL 9 hours after presentation. The patient was transferred to the intensive care unit. Echocardiogram (TTE) revealed an ejection fraction (EF) of 45% and hypertrabeculation. Guideline-directed medical therapy (GDMT) for heart failure was initiated. The patient was extubated on day 3 and underwent heart catheterization on day 5, also yielding unremarkable findings. A repeat TTE showed an improved EF of 60%. On day 8, CBV testing results returned positive for antibodies to serotypes B1-B6. Cardiac magnetic resonance confirmed biventricular cardiac hypertrabeculation. Subsequently, on day 12, the patient underwent implantable cardiac defibrillator placement for secondary prevention of sudden cardiac death. Discharge occurred on day 14.

Discussion: This case emphasizes the critical need for vigilance and genetic testing in assessing young individuals with sudden cardiac events. Beyond the initial ventricular fibrillation arrest, the coexistence of CBV infection, heart failure, and NC highlights the multifactorial nature of such incidents.