Several cardiac outcomes have been reported with West Nile-encephalitis; however, the underlying pathophysiology remains complex. We present a 42-year-old female, with multiple sclerosis, whose neurological symptoms and respiratory decline were finally explained by the diagnosis of West Nile-encephalitis. During her admission, the isolated peaked T-waves indicated the underlying stress-induced cardiomyopathy. The absence of all other causes of hyperacute T-waves, their subsequent resolution with the resolution of infection and improvement in wall motion abnormalities, further supported the association. This case highlights the importance of considering hyperacute T-waves in an approach towards the diagnosis of WNV-encephalitis related atypical variant of stress-induced cardiomyopathy.
References
[1]
Ajam, M., Abu-Heija, A.A., Shokr, M., Ajam, F. and Saydain, G. (2019) Sinus Bradycardia and QT Interval in West Nile Virus Encephalitis: A Case Report. Cureus, 11, e3821.
[2]
Kushawaha, A., Jadonath, S. and Mobarakai, N. (2009) West Nile Virus Myocarditis Causing a Fatal Arrhythmia: A Case Report. Cases Journal, 2, Article 7147. https://doi.org/10.1186/1757-1626-2-7147
[3]
Levis, J.T. (2015) ECG Diagnosis: Hyperacute T Waves. The Permanente Journal, 19, 79. https://doi.org/10.7812/TPP/14-243
[4]
Obeyesekere, I. and Hermon, Y. (1973) Arbovirus Heart Disease: Myocarditis and Cardiomyopathy Following Dengue and Chikungunya Fever—A Follow-Up Study. American Heart Journal, 85, 186-194. https://doi.org/10.1016/0002-8703(73)90459-6
[5]
Friedman, R.A., Kearney, D.L., Moak, J.P., Fenrich, A.L. and Perry, J.C. (1994) Persistence of Ventricular Arrhythmia after Resolution of Occult Myocarditis in Children and Young Adults. Journal of the American College of Cardiology, 24, 780-783. https://doi.org/10.1016/0735-1097(94)90029-9
[6]
Espinosa, R., Schelb, K. and Liu, A. (2016) Idioventricular Rhythm in a Case of West Nile Encephalomyelitis. Journal of Neuroinfectious Diseases, 7, 1-3.
[7]
Gao, A.R., Nichols, L. and Mannuru, D. (2022) A Rare Case of West Nile Virus-Associated Cardiomyopathy. Cureus, 14, e28473.
[8]
Sovari, A.A., Assadi, R., Lakshminarayanan, B. and Kocheril, A.G. (2007) Hyperacute T Wave, The Early Sign of Myocardial Infarction. The American Journal of Emergency Medicine, 25, 859.e1-859.e7. https://doi.org/10.1016/j.ajem.2007.02.005
[9]
Somers, M.P., Brady, W.J., Perron, A.D. and Mattu, A. (2002) The Prominent T Wave: Electrocardiographic Differential Diagnosis. The American Journal of Emergency Medicine, 20, 243-251. https://doi.org/10.1053/ajem.2002.32630
[10]
Surawicz, B. (1967) Relationship between Electrocardiogram and Electrolytes. American Heart Journal, 73, 814-834. https://doi.org/10.1016/0002-8703(67)90233-5
[11]
Brady, W.J. and Chan, T.C. (1999) Electrocardiographic Manifestations: Benign Early Repolarization. Journal of Emergency Medicine, 17, 473-478. https://doi.org/10.1016/S0736-4679(99)00010-4
[12]
Namgung, J. (2014) Electrocardiographic Findings in Takotsubo Cardiomyopathy: ECG Evolution and Its Difference from the ECG of Acute Coronary Syndrome. Clinical Medical insights-Cardiology, 8, 29-34. https://doi.org/10.4137/CMC.S14086
[13]
De Chazal, H.M., Buono, M.G.D., Keyser-Marcus, L., Ma, L., Moeller, F.G., Berrocal, D. and Abbate, A. (2018) Stress Cardiomyopathy Diagnosis and Treatment: JACC State-of-the-Art Review. Journal of American College of Cardiology, 72, 1955-1971. https://doi.org/10.1016/j.jacc.2018.07.072
