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Clinical Overlap Between Myopericarditis and Stress Induced Cardiomyopathy: A Diagnostic and Therapeutic Challenge

Patient: Female, 47 Final Diagnosis: Stress induced cardiomyopathy Symptoms: Chest pain Medication: — Clinical Procedure: Catch • echo Specialty: Cardiology OBJECTIVE: Challenging differential diagnosis BACKGROUND: Stress induced cardiomyopathy (SIC) is characterized by non-obstructive coronary arte...

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Autores principales: Sharma, Toishi, Tigadi, Supriya M., Baldwin, Jennifer, Tabtabai, Sara R.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: International Scientific Literature, Inc. 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6402271/
https://www.ncbi.nlm.nih.gov/pubmed/30804319
http://dx.doi.org/10.12659/AJCR.912169
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author Sharma, Toishi
Tigadi, Supriya M.
Baldwin, Jennifer
Tabtabai, Sara R.
author_facet Sharma, Toishi
Tigadi, Supriya M.
Baldwin, Jennifer
Tabtabai, Sara R.
author_sort Sharma, Toishi
collection PubMed
description Patient: Female, 47 Final Diagnosis: Stress induced cardiomyopathy Symptoms: Chest pain Medication: — Clinical Procedure: Catch • echo Specialty: Cardiology OBJECTIVE: Challenging differential diagnosis BACKGROUND: Stress induced cardiomyopathy (SIC) is characterized by non-obstructive coronary arteries and characteristic ventricular apical ballooning. The exact pathogenesis of SIC is not well recognized. We present an unusual case of SIC that mimicked acute myopericarditis and discuss the effect of this masquerading presentation of SIC in recognizing pathophysiological association between myopericarditis and SIC and limitations of current diagnostic criteria. CASE REPORT: A 47-year-old female presented with flu-like illness and pleuritic chest pain. An electrocardiogram (ECG) showed diffuse PR depressions and ST elevations, troponin 5 ng/mL, hemoglobin 14.2 mg/dL, leukocytosis (white blood cell count of 15.1×10(3)/uL) and erythrocyte sedimentation rate (ESR) of 22.4 mm/hour. Echocardiogram showed reduced ejection fraction (EF) with apical ballooning. Catheterization showed non-obstructive coronary disease. The patient was given colchicine and ibuprofen for 1 day with symptom resolution over the next 2 days and repeat echocardiogram with preserved EF. Troponin trended down to 3.24 ng/mL and 0.44 ng/mL, 6 hours apart. ECG showed resolution of PR depressions and subsequent T wave inversions in 1, AVl, V1–V6 by day 3. The diagnosis of myopericarditis was favored by viral prodrome, fever, pleuritic pain, pericardial rub, ECG findings, and elevated ESR. History of emotional stress, characteristic ballooning of left ventricle apex with rapid resolution favored SIC. CONCLUSIONS: This case showed that SIC and myocarditis need not be mutually exclusive and differentiating clinically between these 2 entities can be difficult. Alternatively, SIC can accompany other cardiac conditions like myocardial infarction, pericarditis, and myocarditis making diagnosis and management challenging. Clinicians need to be cautious while making this differentiation as duration and type of therapy may be significantly different. SIC can be considered a variant of regional inflammatory myocarditis wherein pericarditis may result secondary to extension of myocardial inflammation to overlying pericardium. The current Mayo Clinic criteria for diagnosis of SIC appears to be outdated, not accounting for such atypical presentations, and therefore needs to be revised.
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spelling pubmed-64022712019-03-29 Clinical Overlap Between Myopericarditis and Stress Induced Cardiomyopathy: A Diagnostic and Therapeutic Challenge Sharma, Toishi Tigadi, Supriya M. Baldwin, Jennifer Tabtabai, Sara R. Am J Case Rep Articles Patient: Female, 47 Final Diagnosis: Stress induced cardiomyopathy Symptoms: Chest pain Medication: — Clinical Procedure: Catch • echo Specialty: Cardiology OBJECTIVE: Challenging differential diagnosis BACKGROUND: Stress induced cardiomyopathy (SIC) is characterized by non-obstructive coronary arteries and characteristic ventricular apical ballooning. The exact pathogenesis of SIC is not well recognized. We present an unusual case of SIC that mimicked acute myopericarditis and discuss the effect of this masquerading presentation of SIC in recognizing pathophysiological association between myopericarditis and SIC and limitations of current diagnostic criteria. CASE REPORT: A 47-year-old female presented with flu-like illness and pleuritic chest pain. An electrocardiogram (ECG) showed diffuse PR depressions and ST elevations, troponin 5 ng/mL, hemoglobin 14.2 mg/dL, leukocytosis (white blood cell count of 15.1×10(3)/uL) and erythrocyte sedimentation rate (ESR) of 22.4 mm/hour. Echocardiogram showed reduced ejection fraction (EF) with apical ballooning. Catheterization showed non-obstructive coronary disease. The patient was given colchicine and ibuprofen for 1 day with symptom resolution over the next 2 days and repeat echocardiogram with preserved EF. Troponin trended down to 3.24 ng/mL and 0.44 ng/mL, 6 hours apart. ECG showed resolution of PR depressions and subsequent T wave inversions in 1, AVl, V1–V6 by day 3. The diagnosis of myopericarditis was favored by viral prodrome, fever, pleuritic pain, pericardial rub, ECG findings, and elevated ESR. History of emotional stress, characteristic ballooning of left ventricle apex with rapid resolution favored SIC. CONCLUSIONS: This case showed that SIC and myocarditis need not be mutually exclusive and differentiating clinically between these 2 entities can be difficult. Alternatively, SIC can accompany other cardiac conditions like myocardial infarction, pericarditis, and myocarditis making diagnosis and management challenging. Clinicians need to be cautious while making this differentiation as duration and type of therapy may be significantly different. SIC can be considered a variant of regional inflammatory myocarditis wherein pericarditis may result secondary to extension of myocardial inflammation to overlying pericardium. The current Mayo Clinic criteria for diagnosis of SIC appears to be outdated, not accounting for such atypical presentations, and therefore needs to be revised. International Scientific Literature, Inc. 2019-02-26 /pmc/articles/PMC6402271/ /pubmed/30804319 http://dx.doi.org/10.12659/AJCR.912169 Text en © Am J Case Rep, 2019 This work is licensed under Creative Common Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) )
spellingShingle Articles
Sharma, Toishi
Tigadi, Supriya M.
Baldwin, Jennifer
Tabtabai, Sara R.
Clinical Overlap Between Myopericarditis and Stress Induced Cardiomyopathy: A Diagnostic and Therapeutic Challenge
title Clinical Overlap Between Myopericarditis and Stress Induced Cardiomyopathy: A Diagnostic and Therapeutic Challenge
title_full Clinical Overlap Between Myopericarditis and Stress Induced Cardiomyopathy: A Diagnostic and Therapeutic Challenge
title_fullStr Clinical Overlap Between Myopericarditis and Stress Induced Cardiomyopathy: A Diagnostic and Therapeutic Challenge
title_full_unstemmed Clinical Overlap Between Myopericarditis and Stress Induced Cardiomyopathy: A Diagnostic and Therapeutic Challenge
title_short Clinical Overlap Between Myopericarditis and Stress Induced Cardiomyopathy: A Diagnostic and Therapeutic Challenge
title_sort clinical overlap between myopericarditis and stress induced cardiomyopathy: a diagnostic and therapeutic challenge
topic Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6402271/
https://www.ncbi.nlm.nih.gov/pubmed/30804319
http://dx.doi.org/10.12659/AJCR.912169
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