10th May 2025

Mr Johnson, a 46-year-old bus driver, presents to the cardiology clinic following a recent echocardiogram which showed global hypokinesis of the left ventricle and an ejection fraction of 40%.

Mr Johnson, a 46-year-old bus driver, presents to the cardiology clinic following a recent echocardiogram which showed global hypokinesis of the left ventricle and an ejection fraction of 40%. ECG shows sinus tachycardia and nonspecific ST-T wave changes. On discussion, he reports a two-month history of increasing difficulty breathing with minimal exertion and recurrent episodes of sharp chest pain. He has also noticed a decrease in exercise tolerance and persistent generalised fatigue.

What feature of his presentation is suggestive of poor prognosis in myocarditis?

Select the SINGLE most appropriate option from the list below. Select ONE option only.