Syncope and Inferior ST Elevations: A Diagnosis Within the Heart

A 53 year old woman with a history of diabetes and hypertension presented with syncope, hypotension, and electrocardiography demonstrating inferior ST elevations. The week prior to admission she treated an episode of left knee pain with an admixture of Chinese herbs. Two days prior to presentation she noted the onset of fevers, myalgias and dizziness culminating in syncope the day of admission. Initial electrocardiogram demonstrated complete heart block and junctional escape with inferior ST elevations. Cardiac catheterization demonstrated no epicardial coronary disease. Laboratory studies revealed acute kidney injury, elevated cardiac biomarkers, and a normal white blood cell count with normal differential. Upon transfer to our hospital, the patient was hypotensive requiring temporary ventricular pacing and vasopressor support. Echocardiogram demonstrated severe systolic dysfunction with LVEF of 31%. On arrival, she was noted to have episodes of monomorphic ventricular tachycardia. Etiologies of fulminan...