A Fainting Teenager

A 13-year-old female presented to the emergency department after a syncopal episode. This episode was preceded by a 3-day viral prodrome consisting of a subjective fever, upper respiratory symptoms, and fatigue. She was found to have severe bradycardia secondary to complete heart block and cardiogenic shock resulting in multisystem organ failure. The patient required transthoracic pacing in the emergency department with emergent transvenous pacing in the pediatric intensive care unit. A comprehensive evaluation for the underlying etiology of her heart block, cardiogenic shock, and multisystem organ failure revealed viral myocarditis.