A 31-year-old woman with ulcerative colitis presents with one week of rapidly worsening heart failure and recurrent sustained ventricular tachycardia. Endomyocardial biopsy shows extensive myocyte necrosis infiltrated by lymphocytes and abundant multinucleated giant cells. The most appropriate next step regarding prognosis and management is:

• A Reassure that spontaneous recovery is expected with supportive care alone
• B Perform coronary angiography and plan revascularization
• C Prescribe anticoagulation only and review in six months
• D Start immunosuppression and list for transplantation early given a very poor prognosis without it ✓

Explanation

Giant cell myocarditis is distinguished from ordinary viral myocarditis by rapid progression, refractory ventricular arrhythmias, association with autoimmune disease such as inflammatory bowel disease, and a median survival measured in months without treatment. Management combines immunosuppression with early evaluation for cardiac transplantation. Viral myocarditis often recovers spontaneously, which is exactly why this entity must be recognized separately on biopsy.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.