Eosinophilic myocarditis usually results from myocardial damage as a result of drugs or parasites, and is generally associated with increased peripheral eosinophil count. This form of myocarditis is difficult to diagnose clinically. A 25 year-old previously healthy woman was transferred from a local clinic because of hypotension and dyspnea with sudden cardiogenic shock after a three day history of gastrointestinal illness. Echocardiography revealed concentric left ventricular wall thickening with moderate pericardial effusion. Biopsy of endomyocardial tissue from the right ventricle showed diffuse infiltration of inflammatory cells, mostly eosinophils, even though the patient had a peripheral eosinophil count that was normal at the time of biopsy. The patient was treated with corticosteroids for the symptoms of pericarditis, and she recovered without cardiac sequelae, clinically and echocardiographically. We here report a case of acute eosinophilic myopericarditis, with cardiogenic shock, diagnosed by endomyocardial biopsy with normal peripheral eosinophil count at the time of biopsy, and complete recovery without sequelae.
Shock, Cardiogenic/blood/*etiology ; Pericarditis/blood/*diagnosis ; Myocarditis/blood/*diagnosis ; Leukocyte Count ; Humans ; Female ; *Eosinophils ; Eosinophilia/blood/*diagnosis ; Adult ; Acute Disease

Pericarditis and myocarditis are characterised by electrocardiographic changes and elevated cardiac enzymes, respectively, and patients with perimyocarditis often complain of chest discomfort. These findings are nonspecific and often lead to diagnostic difficulties, as ST-elevation myocardial infarction commonly presents in a similar fashion. Clinical differentiation between perimyocarditis and myocardial infarction are especially important because adverse side effects can occur if reperfusion therapy is administered for a patient with acute pericarditis or if a diagnosis of acute myocardial infarction is missed. We herein describe a case of perimyocarditis with ST elevation and raised cardiac markers, which led to two emergency coronary angiographies that were subsequently found to be normal. We include the three serial electrocardiographies (ECGs) performed to show the characteristic features of perimyocarditis and further discuss the importance of identifying typical and atypical ECG features of pericarditis.
Acute Disease ; Aged ; Biopsy ; Blood Pressure ; Coronary Angiography ; Electrocardiography ; Female ; Humans ; Myocardial Infarction ; pathology ; Myocarditis ; diagnosis ; physiopathology

It is often possible to diagnose a pheochromocytoma only when a disastrous cardiac complication like a hypertensive crisis, episodes of unexpected left ventricular failure, myocarditis, arrhythmias, myocardial infarction and sudden death appears secondarily. We revealed that a patient who had been treated with a reversible left ventricular systolic dysfunction with cardiogenic indeed had a pheochromocytoma. Upon initial admission, a 35 years old man had upper respiratory tract infection and abdominal discomfort. Blood pressure was 140/90 mmHg and EKG showed transiently paroxysmal supraventricular tachycardia. Eight hours after admission, he appeared to be in cardiogenic shock. Echocardiography showed extensive global hypokinesia with severe left ventricular systolic dysfunction. Following conservative management he progressively recovered normal cardiac function although we did not discern the etiology of the left ventricular systolic dysfunction. He was readmitted six months later due to episodic headache and high blood pressure. Fortunately, due to the history of reversible left ventricular systolic dysfunction with cardiogenic shock, we were able to quickly assess him as having a pheochromocytoma. The laboratory data and radiological findings were compatible with this tumor, which was subsequently successfully removed through surgery. We suggest that the diagnosis of pheochromocytoma should be considered in young patients presenting with acute heart failure of non-specific origin.
Adult ; Arrhythmias, Cardiac ; Blood Pressure ; Death, Sudden ; Diagnosis ; Echocardiography ; Electrocardiography ; Headache ; Heart Failure ; Humans ; Hypertension ; Hypokinesia ; Myocardial Infarction ; Myocarditis ; Pheochromocytoma* ; Respiratory Tract Infections ; Shock ; Shock, Cardiogenic* ; Tachycardia, Supraventricular

BACKGROUND: Because of its protean clinical manifestations, diagnosis of acute myocarditis is quite limited unless proved by endomyocardial biospy. However endomyocardial biopsy is not always applicable in these patients. Neither there have been clear clinical criteria for diagnosis nor studies in regard to prognostic factors are available. We retrospectively evaluated clinical features and prognosis of patients with biopsy proven and/or clinically suspected acute myocarditis according to the status of the left ventricular systolic function. METHOD: Thirty six patients of acute myocarditis were enrolled. Eighteen patients were diagnosed by endomyocardial biopsy. We selected clinical diagnostic criteria for this disorder based on the clinicalpaboratory, echocardiographic and ECG findings obtained from this biopsy-proven acute myocarditis. Another 18 patients were selected matching these diagnostic criteria. We divided these thirty-six patients into two groups depending on the left ventricular systolic function : Group 1, EF(3)40(n=20); Group 2, EF<40(n=16). We compared clinical features and prognosis between the two groups. RESULTS: 1) The mean age of Group 1 was 39.7+/-13.6 years(male 12). The mean age of Group 2 was 34.0+/-14.7 years(male 11). Diastolic blood pressure at admission was significantly lower in Group 2 than in Group 1(82+/-10mmHg vs 67+/-15mmHg, p<0.05). 2) In transmitral Doppler findings, Group 1 had 4 patients(25%) with restrictive physiology while Group 2 had 12 patients(75%)(p<0.05). Global LV hypokinesia was more frequent in Group 2 than in Group 1(11/16(69%) vs 3/11(27%), p<(0.05). 3) During the follow up, there was no death in Group 1. But there were 5 deaths in Group 2. Three-year survival rate of Group 1 was better than that of Group 2(100% vs 75%, p<(0.05). In the eleven surviving patients in Group 2, seven patients(64%) showed recovery of the left ventricular systolic function. CONCLUSION: In acute myocarditis, patients who presented with depressed systolic function showed lower diastolic blood pressure at admission, more frequent occurrence of restrictive physiology, more global hypokinesia rather than regional asynergy, and poorer prognosis.
Biopsy ; Blood Pressure ; Diagnosis ; Echocardiography ; Electrocardiography ; Follow-Up Studies ; Humans ; Hypokinesia ; Myocarditis* ; Physiology ; Prognosis* ; Retrospective Studies ; Survival Rate ; Ventricular Function, Left*