This document summarizes the case of a 20-year-old male presenting with new onset dilated cardiomyopathy. Endomyocardial biopsy revealed lymphocytic infiltrates consistent with viral myocarditis. He was initially stabilized with supportive therapies including an LVAD and ECMO. While his EF improved, he suffered multiple complications during his hospital stay including cardiac tamponade, hemorrhagic stroke, and infections, leaving him with residual deficits.

1. Young Soldier With A Failing Heart Manju Goyal, M.D. Walter Reed Army Medical Center April 2008

6. Dilated Cardiomyopathy www.uptodate.com

8. Importance of Etiology NEJM 2000

11. Biopsy Results Dr. Brendan Graham Dept. of Pathology

12. Normal Myocardium

13. Biopsy – 4x

14. Biopsy – 20x

15. Biopsy – 40x

21. Etiology

22. Etiology Braunwald 2007

23. Pathophysiology of Viral Myocarditis Braunwald 2007

25. Immune Response Braunwald 2007 Autoimmune response : auto-antibodies to myosin and other cardiac proteins Overexpression of cytokines (IL-2, INF- γ , TNF- α )

26. Pathophysiology

32. When to consider biopsy? Mayo Clin Proc 2001

33. Circulation 2007

34. Treatment Dr. Barnett Gibbs Dept. of Cardiology

35. Treatment

36. Treatment

41. * *Centrifugal pump vs. corkscrew

44. Treatment

49. Treatment

52. Immunosuppressive Therapies Int Heart J. 2005;46:113.

56. Prognosis NEJM. 2000;342:1077.