infection due to influenza virus is a major burden on the healthcare system and in many cases is associated with severe complications . nearly 60% of the flu - associated hospitalizations reported to cdc 's influenza surveillance system belonged to the age group of 1864 year . in the united states alone , the population - based risk for hospitalization due to influenza infection complications is as high as 150 per 100,000 annually . other more rare cases involve neurological complications , myositis , rhabdomyolysis , and cardiac complications ; including myocarditis and in some cases myocardial infarctions . myocarditis is an inflammatory disease of cardiac muscle , in developed countries ; viral infections most commonly cause this potentially devastating condition . it can cause acute heart failure , chronic dilated cardiomyopathy , sudden death , and is underdiagnosed in the united states . one article reports that the involvement of the myocardium due to influenza has been reported to be 011% , depending on the standards used to define it . another paper reports that the frequency of myocarditis in severely - ill patients due to previous seasonal influenza virus infections is 0.413% , incidence of pandemic influenza associated myocarditis is reported to be even higher . we report a case of influenza a in a 35-year - old male complicated by acute myocarditis and a superinfection of community - acquired pneumonia ( cap ) . the patient is a 35-year - old male , with a past medical history of nephrolithiasis and idiopathic vertigo . he was discharged from another hospital the day prior with a diagnosis of cap and was given doxycycline . one day following discharge , the patient reported to the emergency room ( er ) with syncope after waking up with shortness of breath . physical examination revealed that the patient had a temperature of 101.6 f , heart rate of 98 beats / min in sinus rhythm , blood pressure of 102/66 mmhg , with respirations of 24 breaths / min . patient was alert and oriented times three , and pupils equal , round , and reactive to light . cardiovascular examination was performed which was evaluated to be in regular rate and rhythm with normal s1 and s2 sounds , with a s3 and s4 auscultated . electrocardiograph was done and showed a sinus rhythm of 119 with multifocal preventricular contractions , and nonspecific st and t wave changes followed by ventricular tachycardia ( vt ) . chest computed tomography ( ct scan ) showed small left lower lobe consolidation . while in the er he developed vt patient was defibrillated twice and went back into sinus rhythm . the patients had creatine kinase - mb 11.5 ng / ml and a troponin of 0.12 ng / ml . comprehensive metabolic panel revealed elevated serum glucose at 142 mg / dl and transaminasemia with an aspartate aminotransferase ( ast ) of 255 iu / l and alanine transaminase ( alt ) of 105 iu / l . patient was transferred to the coronary care unit and a cardiac catheterization demonstrated non - obstructive coronary artery disease with a low ejection fraction of approximately 30% . cardiac magnetic resonance imaging was done and showed four - chamber enlargement with diffuse generalized dysfunction . no focal areas of enhancement were seen to suggest sites of inflammation , infection , or scarring . serology for influenza virus was found to be positive for influenza a. patient was started on furosemide 80 mg intravenously ( iv ) and then 12 h later was changed to 40 mg iv every 12 h for acute biventricular systolic heart failure . amiodarone was started at 900/500 mg in d5w 1ml / min iv for 6 h , then 0.5 ml / minute for the vt . there are many severe complications which can develop with influenza a infection , included in these are pulmonary manifestations , musculoskeletal , neurologic , and cardiac . the chance of developing a severe complication dramatically increases depending on the patient 's age , and associated comorbidities or other risk factors such as age , obesity , and asthma . the majority of these hospitalizations could be eliminated with a yearly influenza vaccination . particular emphasis on the importance of vaccination should be given to those with the abovementioned risk factors . in a moderately , well - vaccinated population of older adults , laboratory - confirmed influenza virus accounted for 9.3% of all respiratory hospitalizations , and influenza vaccination prevented 61.2% of such hospitalizations . in healthy individuals , influenza vaccine prevents 5080% of infections with influenza depending on how well the match of the specific subtype has been predicted for that specific season and virus . the fact that the " gold standard " for diagnosis is endomyocardial biopsy , which is very invasive and is prone to sampling errors and an undefined sensitivity , is another explanation for underreporting of myocarditis in influenza infections . hence , other methods of detection are used including echocardiography , mri , and coronary angiography . the male presented in this case was diagnosed with acute myocarditis based on the instrumentation , along with clinical manifestations , including the acute onset of heart failure , elevated cardiac enzymes , and transient cardiac global dysfunction . the influenza a virus was detected in the patient using serology and ideally a convalescent titer 4 weeks later . the patient 's clinical course coupled with the detection of influenza a suggests the viral infection as the primary cause of the myocarditis . it should be recognized that influenza a is a major reason for serious hospitalizations and increased length of stay for reasons including myocarditis , bacterial pneumonia , asthma , or bronchitis exacerbations . the majority of these hospitalizations and long duration length of stays could be prevented with the seasonal vaccination offered in a number of locations .
vaccination continues to be a valuable and simple procedure to guard patients from an illness that may prevent them from completing their normal everyday tasks , missing days of work , and even lead to unnecessary sequelae . 
 the following case describes one of the many complications that are seen on a regular basis in any community hospital in different regions of the world . 
 the objective of this publication is to remind the public and practitioner of the urgency to vaccinate each season ; thereby , curbing the virus 's ability to mutate and preventing unwanted consequences such as bacterial super infection or myocarditis .