scholarly journals Idiopathic eosinophilic myocarditis presenting with features of an acute coronary syndrome

2020 ◽  
Vol 7 (1) ◽  
pp. K1-K6 ◽  
Author(s):  
Nam Tran ◽  
Chun Shing Kwok ◽  
Sadie Bennett ◽  
Karim Ratib ◽  
Grant Heatlie ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Complete Recovery ◽  
Left Ventricular ◽  
Full Blood Count ◽  
Lv Function ◽  
List Type ◽  
Coronary Angiogram ◽  
Coronary Syndrome ◽  
Eosinophilic Myocarditis

Summary A 62-year-old female was admitted with severe left-sided chest pain, nausea and pre-syncope. She had widespread T wave inversion on ECG and elevated troponins and was suspected to have an acute coronary syndrome event. Invasive coronary angiogram revealed normal coronary anatomy with no flow-limiting lesions. Echocardiography and cardiac MRI revealed impaired left ventricular (LV) systolic impairment, a mobile LV apical thrombus and a moderate global pericardial effusion with no significant compromise. Full blood count analysis indicated the patient to have significant eosinophilia, and the patient was diagnosed with idiopathic eosinophilic myocarditis. She was commenced on Prednisolone and Apixaban, and eosinophil levels returned to normal after 10 days of steroids. Over the course of 3 months, the patient had a complete recovery of her LV function and resolution of the LV thrombus. This case highlights a rare, reversible case of idiopathic eosinophilic myocarditis which may present similar to acute coronary syndrome. Learning points: Eosinophilic myocarditis (EM) is a rare disease that can exhibit symptoms similar to acute coronary syndrome events. The diagnosis of EM should be considered in patients with chest pain, normal coronary angiogram and pronounced eosinophilia levels. Endomyocardial biopsy is the gold standard diagnostic tool; however, it has a low sensitivity detection rate and its use is not indicated in some patients. Echocardiography is useful in the initial detection of cardiac involvement and complications. However, echocardiography lacks diagnostic specificity for all forms of myocarditis including EM. Cardiac magnetic resonance is a useful method and may add in diagnosing all forms of myocarditis including EM. Patients with EM should be identified promptly and treated with high doses of oral glucocorticoid to reduce the risk of permanent cardiac dysfunction.

Takotsubo cardiomyopathy associated with adrenal insufficiency in the context of long-term steroid use mimicking acute coronary syndrome

2021 ◽  
Vol 14 (1) ◽  
pp. e234983
Author(s):  
Timothy Bagnall ◽  
Ying Ran Tow ◽  
Nicholas Bunce ◽  
Zoe Astroulakis
Keyword(s):  
Acute Coronary Syndrome ◽  
Adrenal Insufficiency ◽  
Takotsubo Cardiomyopathy ◽  
Left Ventricular ◽  
Lv Function ◽  
Rapid Improvement ◽  
Steroid Use ◽  
Coronary Syndrome ◽  
First Case

Takotsubo cardiomyopathy (TCMP) is an important, though under-recognised, syndrome which mimics acute coronary syndrome (ACS) presenting with similar clinical, biochemical and ECG features. A 68-year-old man was referred as ACS for emergency coronary angiography; however, a history of lethargy, weight loss and electrolyte abnormalities prompted further investigations. Angiography was postponed, adrenal insufficiency confirmed and steroid replacement commenced. Echocardiography demonstrated reduced left ventricular (LV) function (45%) with regional wall motion abnormalities, although angiography confirmed unobstructed arteries. Steroid replacement induced a rapid improvement in symptoms and LV function. Few cases of TCMP associated with adrenal insufficiency have been reported. This appears to be the first case describing TCMP precipitated by new-onset secondary adrenal insufficiency following long-term steroid use in a male patient, and highlights the importance of considering TCMP in patients presenting with suspected ACS. Here, prompt recognition and treatment of a serious underlying disorder prevented a potentially life-threatening Addisonian crisis.

scholarly journals Study of Cardiac Troponin I level in Acute Coronary Syndrome and its correlation with Left Ventricular Systolic Function

2019 ◽  
Vol 12 (1) ◽  
pp. 24-29
Author(s):  
Mohammad Jakir Hossain ◽  
Khondoker Asaduzzaman ◽  
Solaiman Hossain ◽  
Muhammad Badrul Alam ◽  
Nur Hossain
Keyword(s):  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Cardiac Troponin ◽  
Troponin I ◽  
Systolic Function ◽  
Left Ventricular ◽  
Cardiac Troponin I ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Coronary Syndrome

Background: In the diagnosis of acute coronary syndrome, cardiac troponin I is highly reliable and widely available biomarker. Serum level of cardiac troponin I is related to amount of myocardial damage and also closely relates to infarct size. Our aim of the study is to find out the relationship between cardiac troponin I and left ventricular systolic function after acute coronary syndrome. Methods: Total of 132 acute coronary syndrome patients were included in this study after admission in coronary care unit of Sir Salimullah Medical College, Mitford Hospital. Troponin I level was measured at admission and left ventricular ejection fraction (LVEF) was measured by echocardiography between 12-48 hours of onset of chest pain. Results: There was negative correlation between Troponin I at 12 to 48 hours of chest pain with LVEF in these study patients. With a cutoff value of troponin I e”6.8 ng/ml in STEMI patients there is a significant negative relation between 12 to 48 hrs troponin I and LVEF (p<0.001). Sensitivity of troponin I e” 6.8 ng/ml between 12 to 48 hours of chest pain in predicting LVEF <50% in STEMI was 93.75% and specificity was 77.78%. In NSTEMI sensitivity of troponin I e” 4.5 ng/ml between 12 to 48 hours of chest pain in predicting LVEF <50% was 65% and specificity was 54.05%. Conclusion: Serum troponin I level had a strong negative correlation with left ventricular ejection fraction after acute coronary syndrome and hence can be used to predict the LVEF in this setting. Cardiovasc. j. 2019; 12(1): 24-29

scholarly journals A Rare Case of Brugada Phenocopy in A Patient With Takotsubo Cardiomyopathy Masquerading as an Acute Coronary Syndrome

2020 ◽  
Vol 1 (3-4) ◽  
pp. 142-146
Author(s):  
Manjappa Mahadevappa ◽  
Prashanth Kulkarni ◽  
Poornima KS
Keyword(s):  
Acute Coronary Syndrome ◽  
Rare Case ◽  
Pathological Condition ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Lv Function ◽  
Coronary Syndrome ◽  
Cardiac Condition ◽  
As Stress ◽  
Clinical Conditions

Brugada phenocopies (BrP) are clinical entities that are etiologically distinct from true congenital Brugada syndrome. BrP are characterized by type 1 or 2 Brugada electrocardiogram (ECG) patterns in precordial leads V1-V3. However, BrP is elicited by various underlying clinical conditions such as myocardial ischemia, pulmonary embolism, electrolyte abnormalities, or poor ECG filters. Upon resolution of the inciting underlying pathological condition, the BrP ECG subsequently normalizes. Takotsubo (octopus fishing pot) cardiomyopathy (TCM) also known as stress cardiomyopathy is an acute cardiac condition characterized by transient systolic dysfunction of the left ventricular apex and mid-ventricle with depressed LV function mimicking acute coronary syndrome (ACS) and recovers within a few weeks. TCM is most commonly seen in postmenopausal women with intense physical and or emotional stress. We are reporting a rare case of BrP in a patient with TCM masquerading as ACS posing a diagnostic and therapeutic challenge.

Abstract 17059: Ocrelizumab Induced Kounis Syndrome

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Mian Tanveer Ud Din ◽  
Kushani Gajjar ◽  
Valentyna Ivanova
Keyword(s):  
Risk Factors ◽  
Chest Pain ◽  
Fluid Resuscitation ◽  
Cardiac Risk ◽  
Left Ventricular ◽  
Lv Function ◽  
Type I ◽  
Kounis Syndrome ◽  
Cardiac Risk Factors ◽  
Coronary Syndrome

Kounis syndrome(KS), first described in 1991, is defined as concurrence of acute coronary syndrome and anaphylactic events. Primary mechanism of KS is interaction of mast cells with T-lymphocytes and macrophages via multidirectional stimuli leading to platelets activation. Case presentation: A 35 y.o. tennis coach with multiple sclerosis is admitted to the medical ICU with anaphylaxis after receiving Ocrelizumab infusion. Vital signs on presentation are significant for hypotension with blood pressure of 69/30 mm Hg, sinus tachycardia to 110 bpm and hypoxia with SatO2 88% on room air. Other investigations including chest x-ray, EKG and blood work are unrevealing for secondary pathological process outside of anaphylaxis. She undergoes fluid resuscitation followed by epinephrine drip for persistent hypotension. In addition methylprednisolone, famotidine and diphenhydramine are administered. She requires escalating doses of epinephrine and subsequently develops chest pain with troponin elevation to 0.29 ng/ml and EKG concerning for new ST depression and T wave inversion in II, III, aVF, V2 - V6 leads. Urgent echocardiography revealed normal biventricular function with no wall motion abnormalities and is only significant for moderate MR. Given excellent underlying functional capacity and no underlying cardiac risk factors, she was treated for Kounis syndrome by treating underlying anaphylaxis and weaning epinephrine as able with additional fluid resuscitation. Her chest pain resolved and EKG normalized with eventual discontinuation of epinephrine. Repeat echocardiography revealed preserved left ventricular (LV) function and mild MR. Discussion: KS is not a rare disease but easily overlooked and infrequently diagnosed. Our patient had the type I variant: endothelial dysfunction or microvascular angina in absence of cardiac risk factors. Inflammatory mediators can cause vasospasm and catecholamines used for treatment may potentiate it therefore requiring thoughtful dosing and appropriate duration of treatment. Prompt recognition is crucial for appropriate management of anaphylatic shock followed by that of ACS if LV function declines or risk factors for cardiac disease are present.

scholarly journals Early Recovery of Left Ventricular Function After Revascularization in Acute Coronary Syndrome

2019 ◽  
Vol 9 (1) ◽  
pp. 24
Author(s):  
Rafik Shenouda ◽  
Ibadete Bytyçi ◽  
Mohamed Sobhy ◽  
Michael Y. Henein
Keyword(s):  
Acute Coronary Syndrome ◽  
Univariate Analysis ◽  
Regional Wall Motion ◽  
Left Ventricular ◽  
Lv Function ◽  
Systolic Strain ◽  
Early Recovery ◽  
Coronary Syndrome ◽  
Peak Systolic Strain ◽  
Before And After

The aim of this study was to assess the accuracy of echocardiographic techniques in detecting the early recovery of left ventricular (LV) function after revascularization in acute coronary syndrome (ACS). In 80 consecutive patients with ACS (age 55.7 ± 9.4 years, 77% male, 15% with CCS Angina III), an echocardiographic examination of left ventricle regional wall motion abnormalities (LV RWMA), peak systolic strain rate (PSSR), peak systolic strain (PSS) and end systolic strain (ESS) was performed before and after percutaneous intervention (PCI). Of the 80 patients, one vessel stenosis (>70%) was present in 53 (66%), two vessel disease in 12 (15%) and multivessel disease in 15 patients (19%). In total, 51% of patients had hypertension, 40% diabetes and 23% dyslipidemia. After PCI, regional PSS, ESS and PSSR of their segments subtended by the culprit vessel improved; left anterior descending-LAD, circumflex-LCx and right coronary-RCA (p<0.05 for all) as well as global S and SR (p < 0.05 for all). In univariate analysis, hypertension (HTN) (β = −0.294 (−0.313–0.047), p = 0.009, smoking β = −0.244 (−0.289–0.015) =0.03, WMA β = −0.317 (−0.284–0.014), p = 0.004 and the number of diseased vessels β = −0.256 (−0.188– 0.054) p=0.03 were predictors of delta global SR. In multivariate analysis, only HTN β = 0.263 (0.005–3.159) and the number of diseased vessels β =0.263 (0.005 - 3.159), p=0.04) predicted delta global SR. In ACS, the echocardiographic regional myocardial deformation is accurate in detecting early recovery of LV myocardial function after culprit lesion revascularization. Also, the findings of this study support the current practice regarding the crucial importance of proximal epicardial vessel PCI treatment on LV function compared to more distal lesions.

scholarly journals ST Segment Elevation in aVR: Clinical Significance in Acute Coronary Syndrome

2013 ◽  
Vol 6 ◽  
pp. CCRep.S11261 ◽  
Author(s):  
Antoine Kossaify
Keyword(s):  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Medical Data ◽  
Current Medical ◽  
Coronary Angiogram ◽  
Bundle Branch Block ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Previous Medical History

A 59-year-old-male patient with no previous medical history presented with oppressive chest pain; initial electrocardiogram showed ST segment elevation in aVR and V1, with intermittent right bundle branch block. Emergent coronary angiogram showed a proximal sub-occlusive stenosis of the left anterior descending artery, and the patient was hemodynamically unstable during the first 72 hours. Insights into the significance of ST segment elevation in aVR are presented and discussed in light of the current medical data.

scholarly journals Morphology of Coronary Artery Disease in a Patient with, Psoriasis Presenting with an Acute Coronary Syndrome

2021 ◽  
Vol 04 (15) ◽  
pp. 01-05
Author(s):  
Ranjit Sharma
Keyword(s):  
Coronary Artery Disease ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Wall Motion ◽  
Lv Function ◽  
Coronary Angiogram ◽  
Coronary Lesion ◽  
Coronary Syndrome ◽  
Artery Disease ◽  
Time Of Presentation

Background: This study was designed to evaluate the patterns of coronary artery disease in patients with Psoriasis presenting with acute coronary syndrome (ACS). Methods: This was a prospective, observational study, conducted on 28 patients with Psoriasis, presenting with acute coronary syndrome undergoing coronary angiogram from September 2017 to March 2021. All patients had undergone coronary angiogram; severity and morphology of coronary lesion were analyzed. Echocardiography was used to analyze LV wall motion and LV function. Results: The study showed that of 28 patients with Psoriasis who presented with ACS, 45.8% of patients were presented with NSTEMI, 39.2% % STEMI, and Unstable angina 15%. The average time of presentation after the onset of the symptom was 14.8 hours. 66 % of patients were a smoker. Coronary involvement 50% had TVD, 40% DVD, and 10% had SVD. In 77.6% culprit vessel was LAD, 10.4% LCX, and 12% RCA. In 75% of patient's coronary lesion was located in the proximal LAD. Chronic total occlusion was found in almost 26% of patients. Extensive LV wall motion abnormality with severe LV systolic dysfunction was noted in Psoriasis patients at the time of presentation (mean LVEF=28%). Conclusions: Psoriasis patients presenting with ACS, associated with increased severity of coronary lesions, multivessel involvement, and depressed LV systolic function.

Sign in / Sign up

Export Citation Format

Share Document