Divergent clinical phenotypes of post-inflammatory interventricular septal injury in young military personnel

Authors

DOI:

https://doi.org/10.14739/2310-1210.2026.3.356649

Keywords:

myocarditis, ventricular septum, atrioventricular block, cardiac magnetic resonance imaging (cardiac MRI), heart failure, sudden cardiac death

Abstract

Post-inflammatory myocardial injury in young, physically active populations like military personnel presents significant diagnostic and prognostic challenges. Inflammation triggered by infections, systemic stress, or thoracic trauma may escape detection by standard electrocardiography (ECG) and biomarkers. When localized within the interventricular septum (IVS), it may impair both conduction and contractility, increasing the risk of adverse cardiac events.

Aim. To demonstrate the clinical heterogeneity of post-inflammatory interventricular septal injury and highlight the role of cardiac magnetic resonance (CMR) imaging in diagnosis and risk stratification.

Materials and methods. A comparative analysis of myocardial changes was conducted in two young male servicemembers who developed significant cardiac manifestations following presumed inflammatory triggers (infection and trauma). Clinical evaluation included ECG, ambulatory rhythm monitoring, serum biomarkers, and CMR.

Results. Both patients demonstrated preserved or only minimally elevated biomarkers, underscoring the limitations of laboratory screening alone. Case 1: a 40-year-old patient developed presyncope after pneumonia and blast-related trauma. Monitoring revealed high-grade atrioventricular block (Mobitz Type II). CMR identified focal intramural late gadolinium enhancement within the basal IVS, necessitating permanent pacemaker implantation. Case 2: a 39-year-old patient presented with acute dyspnea and fatigue after a viral infection

Author Biographies

V. A. Lysenko, Zaporizhzhia State Medical and Pharmaceutical University

MD, PhD, Assistant at the Department of Propaedeutic of Internal Medicine, Radiation Diagnostic and Radiation Therapy, Educational and Scientific Institute of Postgraduate Education

V. V. Syvolap, Zaporizhzhia State Medical and Pharmaceutical University

MD, PhD, DSc, Professor of the Department of Propaedeutic of Internal Medicine, Radiation Diagnostic and Radiation Therapy, Educational and Scientific Institute of Postgraduate Education

I. S. Titova, Municipal Non-Profit Enterprise “City Hospital of Emergency and First Aid”, Zaporizhzhia

MD, Cardiologist

References

  1. Schulz-Menger J, Collini V, Gröschel J, Adler Y, Brucato A, Christian V, et al. 2025 ESC Guidelines for the management of myocarditis and pericarditis. Eur Heart J. 2025;46(40):3952-4041. doi: https://doi.org/10.1093/eurheartj/ehaf192
    | |
  2. Drazner MH, Bozkurt B, Cooper LT, Aggarwal NR, Basso C, Bhave NM, et al. 2024 ACC Expert Consensus Decision Pathway on Strategies and Criteria for the Diagnosis and Management of Myocarditis: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. 2025;85(4):391-431. doi: https://doi.org/10.1016/j.jacc.2024.10.080
    | |
  3. Tschöpe C, Ammirati E, Bozkurt B, Caforio A, Cooper LT, Felix SB, et al. Myocarditis and inflammatory cardiomyopathy: current evidence and future directions. Nat Rev Cardiol. 2021;18(3):169-93. doi: https://doi.org/10.1038/s41569-020-00435-x
    | |
  4. Schultheiss HP, Baumeier C, Aleshcheva G, Bock CT, Escher F. Viral Myocarditis-From Pathophysiology to Treatment. J Clin Med. 2021;10(22):5240. doi: https://doi.org/10.3390/jcm10225240
    | |
  5. Lauriero F, Vita CV, Perazzolo A, Sanseverino G, Moliterno E, Rovere G, et al. Acute Myocarditis and Inflammatory Cardiomyopathies: Insights From Cardiac Magnetic Resonance Findings. Echocardiography. 2025;42(2):e70099. doi: https://doi.org/10.1111/echo.70099
    | |
  6. Aquaro GD, Ghebru Habtemicael Y, Camastra G, Monti L, Dellegrottaglie S, Moro C, et al. Prognostic Value of Repeating Cardiac Magnetic Resonance in Patients With Acute Myocarditis. J Am Coll Cardiol. 2019;74(20):2439-48. doi: https://doi.org/10.1016/j.jacc.2019.08.1061
    | |
  7. Zeppenfeld K, Tfelt-Hansen J, de Riva M, Winkel BG, Behr ER, Blom NA, et al. 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J. 2022;43(40):3997-4126. doi: https://doi.org/10.1093/eurheartj/ehac262
    | |
  8. Peretto G, Sala S, Rizzo S, Palmisano A, Esposito A, De Cobelli F, et al. Ventricular Arrhythmias in Myocarditis: Characterization and Relationships With Myocardial Inflammation. J Am Coll Cardiol. 2020;75(9):1046-57. doi: https://doi.org/10.1016/j.jacc.2020.01.036
    | |
  9. Franzos MA, Hellwig LD, Thompson A, Wu H, Banaag A, Hulsopple C, et al. No One Left Behind: Incidence of Sudden Cardiac Arrest and 30-Day Survival in Military Members. Am J Med. 2025;138(6):987-93. doi: https://doi.org/10.1016/j.amjmed.2025.02.003
    | |
  10. Messner M, Mayr A, Zaruba MM, Poelzl G. Eosinophilic myocarditis complicated by permanent atrioventricular nodal block: a case report. Eur Heart J Case Rep. 2022;6(2):ytac055. doi: https://doi.org/10.1093/ehjcr/ytac055
    | |
  11. Glikson M, Nielsen JC, Kronborg MB, Michowitz Y, Auricchio A, Barbash IM, et al. 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Eur Heart J. 2021;42(35):3427-520. doi: https://doi.org/10.1093/eurheartj/ehab364
    | |
  12. Nagueh SF, Sanborn DY, Oh JK, Anderson B, Billick K, Derumeaux G, et al. Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography and for Heart Failure With Preserved Ejection Fraction Diagnosis: An Update From the American Society of Echocardiography. J Am Soc Echocardiogr. 2025;38(7):537-69. doi: https://doi.org/10.1016/j.echo.2025.03.011
    | |
  13. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2015;16(3):233-70. doi: https://doi.org/10.1093/ehjci/jev014
    | |
  14. Smiseth OA, Morris DA, Cardim N, Cikes M, Delgado V, Donal E, et al. Multimodality imaging in patients with heart failure and preserved ejection fraction: an expert consensus document of the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2022;23(2):e34-e61. doi: https://doi.org/10.1093/ehjci/jeab154
    | |
  15. Tudela Martínez JI, Alcaraz Pérez P, Martínez Encarnación L, González-Carrillo J, Rodríguez Sánchez D, Sarabia Tirado F, et al. Cardiac Magnetic Resonance in Adults: An Updated Review of the Diagnostic Approach to Major Heart Diseases. J Clin Med. 2025;14(20):7323. doi: https://doi.org/10.3390/jcm14207323
    | |
  16. Chen Y, Sun Z, Xu L, Liu J, Li Y, Zhang N, et al. Diagnostic and Prognostic Value of Cardiac Magnetic Resonance Strain in Suspected Myocarditis With Preserved LV-EF: A Comparison Between Patients With Negative and Positive Late Gadolinium Enhancement Findings. J Magn Reson Imaging. 2022;55(4):1109-19
    | |
  17. Gaizauskiene K, Leketaite K, Glaveckaite S, Valeviciene N. Diagnostic Value of Cardiovascular Magnetic Resonance T1 and T2 Mapping in Acute Myocarditis: A Systematic Literature Review. Medicina (Kaunas). 2024;60(7):1162. doi: https://doi.org/10.3390/medicina60071162
    | |
  18. Muser D, Chahal AA, Selvanayagam JB, Nucifora G. Clinical Applications of Cardiac Magnetic Resonance Parametric Mapping. Diagnostics (Basel). 2024;14(16):1816. doi: https://doi.org/10.3390/diagnostics14161816
    | |
  19. Haberka M, Rajewska-Tabor J, Wojtowicz D, Jankowska A, Miszalski-Jamka K, Janus M, et al. A distinct septal pattern of late gadolinium enhancement specific for COVID-induced myocarditis: A multicenter cardiovascular magnetic resonance study. Kardiol Pol. 2023;81(5):463-71. doi: https://doi.org/10.33963/KP.a2023.0054
    | |
  20. O’Brien AT, Gil KE, Varghese J, Simonetti OP, Zareba KM. T2 mapping in myocardial disease: a comprehensive review. J Cardiovasc Magn Reson. 2022;24(1):33. doi: https://doi.org/10.1186/s12968-022-00866-0
    | |
  21. Taub CC, Stainback RF, Abraham T, Forsha D, Garcia-Sayan E, Hill JC, et al. Guidelines for the Standardization of Adult Echocardiography Reporting: Recommendations From the American Society of Echocardiography. J Am Soc Echocardiogr. 2025;38(9):735-74. doi: https://doi.org/10.1016/j.echo.2025.06.001
    | |
  22. McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, et al. 2023 focused update of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2023;44(37):3627-39. doi: https://doi.org/10.1093/eurheartj/ehad195
    | |
  23. Prasad SK, Akbari T, Bishop MJ, Halliday BP, Leyva-Leon F, Marchlinski F. Late gadolinium enhancement imaging and sudden cardiac death. Eur Heart J. 2025;46(36):3555-68. doi: https://doi.org/10.1093/eurheartj/ehaf464
    | |
  24. Unger A, Garot J, Toupin S, Duhamel S, Sanguineti F, Hovasse T, et al. Prognostic Value of Cardiac MRI Late Gadolinium Enhancement Granularity in Participants with Ischemic Cardiomyopathy. Radiology. 2025;314(1):e240806. doi: https://doi.org/10.1148/radiol.240806
    | |
  25. Prochnau D, Kühnemund J, Heyne JP. Reversible high-grade atrioventricular block with septal myocardial edema in Lyme carditis. Herzschrittmacherther Elektrophysiol. 2022;33(3):327-9. English. doi: https://doi.org/10.1007/s00399-022-00879-3
    | |
  26. Fronza M, Thavendiranathan P, Chan V, Karur GR, Udell JA, Wald RM, et al. Myocardial Injury Pattern at MRI in COVID-19 Vaccine-Associated Myocarditis. Radiology. 2022;304(3):553-62. doi: https://doi.org/10.1148/radiol.212559
    | |
  27. Sfairopoulos D, Bazoukis G, Sideris S, Fragakis N, Letsas K, Zekios K, et al. Clinical Significance and Management of Atrioventricular Block Associated With Bradycardic/Antiarrhythmic Drug Therapy: Drug-Induced or Drug-Revealed? J Cardiovasc Electrophysiol. 2025;36(7):1643-53. doi: https://doi.org/10.1111/jce.16697
    | |

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Published

2026-06-11

How to Cite

1.
Lysenko VA, Syvolap VV, Titova IS. Divergent clinical phenotypes of post-inflammatory interventricular septal injury in young military personnel. Zaporozhye Medical Journal [Internet]. 2026Jun.11 [cited 2026Jun.11];28(3):289-96. Available from: https://zmj.zsmu.edu.ua/article/view/356649

Issue

Vol. 28 No. 3 (2026): Zaporozhye Medical Journal

Section

Case Reports

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Copyright (c) 2026 V. A. Lysenko, V. V. Syvolap, I. S. Titova

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