Takotsubo cardiomyopathy, also known as Gebrochenes-Herz syndrome, transient apical ballooning syndrome, apical ballooning cardiomyopathy, stress-induced cardiomyopathy, or broken heart syndrome, is a rare disease triggered by stressful events, such as a high plasma concentration of catecholamines and their metabolites, which resembles acute coronary syndrome. It is characterized by transient regional systolic dysfunction of the left ventricle mimicking acute myocardial infarction. The term Takotsubo originates from the Japanese word for an "octopus trap," which resembles the shape of the ventricle during systole. A 28-year-old woman in the early postpartum period presented to the emergency department with a sudden onset retrosternal chest pain and shortness of breath. At first, electrocardiography and laboratory evaluation workups suggested acute coronary syndrome. Transthoracic echocardiography revealed hypokinesia of the basal and mid left ventricular segments with preserved apical contractility, resulting in a left ventricular ejection fraction of 35%. The patient underwent immediate coronary angiography, which showed normal coronary arteries as well as no obstructive disease. Follow-up echocardiography showed recovery of left ventricular function with an improvement of the left ventricular ejection fraction to 55%, consistent with a diagnosis of reverse Takotsubo cardiomyopathy, occurring in the postpartum period which is an important STEMI mimic. Takotsubo cardiomyopathy is an important differential diagnosis in postpartum women presenting with acute coronary syndrome-like symptoms and requires careful multimodal evaluation to distinguish it from peripartum cardiomyopathy and myocarditis. The patient stabilized following supportive management, with complete recovery of left ventricular function.

To evaluate the diagnostic performance of deep learning-derived left ventricular circumferential strain (DL-LVCS), a method that reduces operator dependency and analysis time compared with conventional feature tracking, in patients with acute myocarditis and preserved LVEF (≥ 55%), and to compare it with feature tracking-derived strain (FT-LVCS). This retrospective study, conducted between January 2021 and December 2024, included 142 patients with acute myocarditis, stratified into preserved EF (AMY-pEF, n = 106, mean age, 31 ± 9 years; 80 male) and reduced EF (n = 36, mean age, 33 ± 12 years; 27 male) groups, alongside 106 age- and sex-matched healthy controls (mean age, 32 ± 7 years; 78 male). A deep learning model integrating PPIM-Net (Pyramid Progressive Image Mapping Network) for segmentation and U-Net for motion tracking was developed to compute DL-LVCS. Conventional LVCS was also obtained. Diagnostic performance was evaluated using ROC analysis, and AUCs were compared with the DeLong test. In the AMY-pEF group, both FT-LVCS (-18.4%±1.2 vs. -19.8% ±1.3) and DL-LVCS (-8.0%±1.4 vs. -10.4%±1.8) were significantly impaired versus controls (both P < 0.001). For diagnosing AMY-pEF, FT-LVCS (cutoff=-19.3%) achieved an AUC of 0.806, with 67.2% sensitivity and 84.5% specificity. DL-LVCS (cutoff=-9.2%) demonstrated significantly higher AUC (0.887), sensitivity (85.9%), and specificity (79.2%) (DeLong P < 0.01). DL-LVCS enables quantification of myocardial deformation and demonstrates higher sensitivity than conventional LVCS for discriminating patients with CMR-defined acute myocarditis and preserved LVEF from healthy controls. It may serve as a supplementary CMR biomarker when standard functional metrics are within normal ranges.

BackgroundThe relationship between acute myocardial injury and prognosis in acute myocarditis (AM) is unclear.PurposeTo evaluate myocardial injury characteristics by cardiovascular magnetic resonance (CMR) tissue parameters and their impact on adverse outcomes of AM patients.Material and MethodsThis retrospective study enrolled 41 patients with fulminant myocarditis (FM, including 17 FM patients without mechanical circulatory support [MCS] and 24 FM patients with MCS) and 35 patients with non-fulminant myocarditis (non-FM). Cine, mapping (native T1, T2, and post-T1), and late gadolinium enhancement (LGE) of the left ventricle were performed during CMR. Adverse clinical outcomes consisted of a primary endpoint, major adverse cardiovascular events (MACEs), and a secondary endpoint, a decline in functional status (defined as New York Heart Association [NYHA] functional classes II-IV).ResultsCompared with patients with non-FM, those in FM with MCS exhibited increased native T1 (P = 0.001), extracellular volume (ECV) (P = 0.018), and LGE (P = 0.005) values. After adjusting for the clinical variables (CRP > 67.9 mg/dL), LGE > 8.4% remained independently associated with adverse clinical outcomes and improved the predicting ability of the model (C-statistic improved from 0.74 to 0.82).ConclusionThe burden of necrosis and fibrosis was greatest in FM with MCS, while edema was similar across groups. Higher LGE% adds incremental prognostic value. A new classification using CRP and LGE improved prediction of adverse outcomes. Thus, CMR evaluation of myocardial injury extent offers variable information to improve risk stratification in FM.

Children and adults can suffer recurrence of myocarditis months to years after their initial presentation; however predictors of recurrence in the pediatric population have not been described to date. We sought to describe cardiac magnetic resonance (CMR) imaging findings and predictors of recurrence in a pediatric cohort. A retrospective cohort study of patients < 21 years, clinically diagnosed with acute myocarditis and who underwent CMR within 14 days of initial presentation was performed. Mann-Whitney U test and Fisher's exact test were used to compare those who fully recovered versus those with recurrence. Of 85 patients who met inclusion, median age 16.3 years (IQR 14.3, 17.5), 72 fully recovered, 5 had recurrence, 5 were lost to follow up and 3 progressed to chronic dilated cardiomyopathy. Median time to CMR following presentation was 2 days (IQR 2, 4) and time to recurrence was 681 days (IQR 386, 855). Compared to those who recovered, patients with recurrence had similar indices of ventricular function, volume, strain and tissue characterization including T1 mapping and T2 mapping on their initial and follow up CMR. Myocarditis may recur in a small proportion of children. These children have similar findings on initial and follow up CMR as those who recover. Further work is needed to identify useful predictors of recurrence in children.

Pacemaker insertion in children presents unique challenges because of their small size and developing anatomy. Since pacemaker insertion is relatively uncommon in pediatric patients, and as a result, specialized technologies for this population remain limited and under-researched. The most common indication for pacemaker insertion in children is congenital or acquired heart block. Congenital heart block is often associated with maternal autoimmune disease, in which autoantibodies damage the developing cardiac conduction system. It may also occur in association with congenital heart disease. Acquired heart block can result from several causes, including postoperative conductive abnormalities and complications of myocarditis. Several types of pacemakers have been studied in pediatric patients, including leadless, transvenous, and epicardial pacemakers. Smaller devices designed specifically for neonates are also being investigated. In addition, temporary pacemakers may be used in acute settings or as a bridge to permanent therapy because they can be implanted more rapidly.

Lyme borreliosis is the most common tick-borne bacterial infection in Europe and is caused by members of the Borrelia burgdorferi sensu lato complex transmitted mainly by Ixodes ricinus. Although Lyme carditis represents an uncommon extracutaneous manifestation, it is clinically important because atrioventricular conduction disease can progress rapidly yet often resolves with timely antibiotic treatment, reducing avoidable permanent pacemaker implantation. This Mini Review synthesizes the European evidence on the microbiological, epidemiological, diagnostic, and surveillance dimensions of Lyme carditis. The European setting is distinct from North America because B. afzelii and B. garinii predominate, species-level attribution of cardiac disease is rarely available, and national Lyme borreliosis surveillance systems differ substantially in definitions, reporting routes, and captured manifestations. Available data suggest that Lyme carditis is rare among medically attended Lyme borreliosis cases but may be clinically relevant among patients with unexplained high-grade or fluctuating atrioventricular block in endemic regions. Diagnosis is complicated by absent tick-bite history or erythema migrans, early seronegativity, background seropositivity, older age at presentation, myocarditis or acute coronary syndrome-like phenotypes, and limited access to confirmatory tissue-based methods. We propose that European surveillance should incorporate cardiology-linked sentinel pathways, particularly before permanent pacemaker implantation, using standardized suspected, probable, and confirmed case categories supported by paired serology when feasible. Multicenter collaboration between cardiology, infectious diseases, microbiology, and public-health networks is needed to define incidence, optimize diagnostic algorithms, and clarify the contribution of European Borrelia species to cardiac involvement.

Previous invasive studies on the Impella device (Abiomed, Danvers, MA, USA) have reported that its effect increases coronary artery perfusion. However, non-invasive evaluation using transthoracic Doppler echocardiography (TTDE) remains limited. We assessed the effects of different Impella support levels on coronary blood flow velocity using TTDE in four patients: two with ST-elevation myocardial infarction (STEMI), one with acute myocarditis, and one with myocardial infarction with non-obstructive coronary arteries (MINOCA) due to coronary spasm. The peak diastolic flow velocity (DPV) at the distal left anterior descending artery was measured for a surrogate of coronary blood flow at various Impella flow settings. In STEMI patients, DPV decreased in parallel with stepwise reductions in Impella support levels. In contrast, patients with acute myocarditis and MINOCA exhibited no significant DPV changes despite adjustments in support levels. These findings suggest that the impact of Impella on coronary flow velocity varies according to underlying disease pathology. In STEMI patients post-percutaneous coronary intervention, Impella-induced left ventricular unloading appears to enhance coronary perfusion, while in cases of myocarditis and MINOCA, microvascular dysfunction and other pathophysiological factors may limit this effect.

Immune checkpoint inhibitors (ICIs) have improved outcomes across multiple solid tumors, but they may trigger immune-related adverse events involving the nervous system, skeletal muscle, myocardium, and liver. ICI-related myositis is uncommon but clinically important and may overlap with myocarditis or other neuromuscular toxicities. Reports in breast cancer remain limited, particularly in HER2-positive disease outside standard immunotherapy settings. We describe a 67-year-old woman with HER2-positive metastatic breast cancer who had received multiple anti-HER2 regimens and had limited tolerance to chemotherapy and endocrine therapy. After multidisciplinary discussion and informed consent, her regimen was adjusted to trastuzumab deruxtecan plus sintilimab because of progressive pulmonary and intracranial disease. After the first cycle, she developed acute bilateral ptosis with mild bilateral lower-extremity weakness, marked creatine kinase elevation (peak CK 8075.3 U/L), CK-MB elevation (206.4 U/L), and severe transaminase elevation. Repetitive nerve stimulation did not show a typical decremental response, left orbicularis oculi fatigue testing was negative, myasthenia gravis-related antibody testing was recommended but declined, and the response to cholinesterase inhibitor therapy was limited. Troponin testing, repeat echocardiography, and cardiac magnetic resonance imaging were not performed. Therefore, the condition was reinterpreted as immune-related myositis with predominant ocular involvement and concomitant hepatitis; concomitant myasthenia gravis remained unproven and myocarditis could not be definitively excluded. Sintilimab was discontinued, and high-dose methylprednisolone was initiated and tapered. Muscle and liver enzymes decreased substantially, and ptosis partially improved. The patient received no further anticancer treatment and died in December 2025; telephone follow-up suggested progressive metastatic breast cancer as the most likely cause. This case highlights that new ocular symptoms accompanied by marked CK elevation after PD-1 inhibitor-containing therapy should prompt early consideration of immune-related myositis, even when classical myasthenia gravis is not supported by the available evidence.

BackgroundAcute Inflammatory Demyelinating Polyradiculoneuropathy (AIDP), the most common form of Guillain-Barré Syndrome (GBS), may rarely be complicated by myocarditis, which results from an inflammatory or autoimmune response. Conversely, acute kidney injury (AKI), caused by osmotic nephrosis, is an uncommon adverse effect associated with maltose-based intravenous immunoglobulin (IVIG) therapy, a common treatment for GBS.Case presentationA 41-year-old diabetic male diagnosed with AIDP received maltose-based IVIG. After 75 g administration, he developed flu-like symptoms and AKI, followed by signs of myocarditis, including elevated troponin, reduced ejection fraction, and ECG changes. IVIG was discontinued early due to these adverse effects. The patient required ICU care and hemofiltration but recovered with supportive treatment.ConclusionThis case highlights myocarditis as a rare complication of GBS and demonstrates that IVIG, while essential in treatment, even though maltose based, can lead to serious adverse effects including AKI, particularly in high-risk patients.