A 29-year-old woman develops rapidly progressive heart failure over two weeks with frequent ventricular tachycardia, poorly responsive to standard therapy. Endomyocardial biopsy shows myocyte necrosis with numerous multinucleated giant cells and abundant eosinophils within a diffuse inflammatory infiltrate. What is the most appropriate next step regarding management?

• A High-dose corticosteroids alone with expected full recovery
• B Antiviral therapy and supportive care
• C Urgent evaluation for cardiac transplantation ✓
• D Implantable cardioverter-defibrillator implantation as definitive therapy

Explanation

Giant cell myocarditis is a fulminant autoimmune myocarditis of young adults characterized by rapid refractory heart failure, arrhythmias, and biopsy findings of multinucleated giant cells with eosinophils. Immunosuppression may temporize but does not cure it, and median survival without transplantation is only months, so early transplant evaluation is the accepted approach. An ICD treats the arrhythmic consequence but does nothing for the relentless myocardial destruction driving the illness.

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.