Viral myocarditis presenting with seizure and electrocardiographic findings of acute myocardial infarction in a 14-month-old child

Acute viral myocarditis is an uncommon but potentially fatal illness in chi ldren. Patients with myocarditis may present with nonspecific symptoms or a typical findings that make diagnosis in the emergency department difficult. We describe a previously healthy 14-month-old child with difficulty breath ing and a tonic-clonic seizure who was subsequently found to have ECG chang es and cardiac marker elevation consistent with acute myocardial infarction . The patient was immediately transferred from our community hospital ED to our tertiary care children's hospital. Shortly after admission, the patien t developed intractable nonperfusing ventricular arrhythmias necessitating extracorporeal membrane oxygenation. Cardiac function did not recover, and the patient required heart transplantation before cessation of bypass. Sero logy and anatomic pathology confirmed coxsackievirus B myocarditis. This ca se illustrates (1) the nonspecific presentation of myocarditis as dyspnea a nd seizure, (2) the manner in which myocarditis can mimic myocardial infarc tion, and (3) the importance of early diagnosis in the ED and transfer to a tertiary care facility.