# A Whispering Heart: Viral Myocarditis Hiding in Plain Sight

## TL;DR

A 14-year-old girl with celiac disease developed severe heart issues from myocarditis and made a full recovery after intensive treatment.

## Contribution

This case highlights myocarditis as a rare but critical cause of sudden heart block and shock in pediatric patients.

## Key findings

- A 14-year-old girl with celiac disease developed fulminant myocarditis leading to complete heart block and cardiogenic shock.
- The patient recovered after treatment with inotropic support, hyperkalemia management, and ECMO.
- The case emphasizes the need for high clinical suspicion of myocarditis in pediatric patients with conduction abnormalities and shock.

## Abstract

We present the case of a 14-year-old girl with a background of celiac disease and no other significant medical history who developed acute complete heart block and cardiogenic shock secondary to fulminant myocarditis. She presented with persistent vomiting and lethargy. An electrocardiogram (ECG) revealed ST-segment elevation. A bedside echocardiogram revealed global hypokinesia. She was found to be in complete heart block and showed biochemical evidence of multi-organ hypoperfusion. Management included emergency inotropic support, hyperkalemia treatment, and extracorporeal membrane oxygenation (ECMO). She made a remarkable recovery, with near normalization of cardiac function and resolution of arrhythmias. This case highlights the importance of high clinical suspicion for myocarditis in pediatric patients presenting with conduction abnormalities and shock.