The velvet myocardium: potential harbinger of death in acute myocarditis?

A case of fulminant myocarditis in a young man is described. Bedside hand-held focused cardiac ultrasound demonstrated severe systolic dysfunction with hypertrophied myocardium. Echocardiogram showed a speckled texture of the myocardium and a "velvet-like" appearance. Unfortunately, the patient developed cardiogenic shock and despite aggressive management, he died. The autopsy showed multifocal lymphohistiocytic infiltration and myocyte injury. We propose that the "velvet" myocardial ultrasonic appearance with ventricular hypertrophy is an indicator of rapid clinical demise.