1.Early Non-Invasive Diagnosis and Treatment of Acute Eosinophlic Myopericarditis by Cardiac Magnetic Resonance.
Eun Young KIM ; Sung A CHANG ; Yoo Kyung LEE ; Jin Oh CHOI ; Yeon Hyeon CHOE
Journal of Korean Medical Science 2011;26(11):1522-1526
We report a case of early non-invasive diagnosis of acute eosinophilic myopericarditis (AEM) by cardiovascular magnetic resonance (CMR) before cardiac biopsy. A 35-yr-old woman presented with a flu-like illness, followed by pleuritic chest pain and shortness of breath. Transthoracic echocardiography revealed mild left ventricular (LV) systolic dysfunction with borderline LV wall thickness and moderate pericardial effusion. The patient had peripheral eosinophilia and CMR was performed immediately at first day of visit before cardiac biopsy. CMR showed diffuse subepicardial high T2 signals and diffuse late gadolinium enhancement in LV. Steroid therapy was immediately initiated and patient's symptom was rapidly improved. Endomyocardial biopsy at hospital day 3 reported multifocal mild infiltration of eosinophils and lymphocytes. The patient was finally confirmed as acute eosinophilic myopericarditis. This presentation emphasizes on the role of CMR which enables early non-invasive diagnosis of AEM and visualize the extent of the myocarditis.
Adult
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Early Diagnosis
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Echocardiography
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Eosinophilia/*diagnosis
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Female
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Gadolinium/diagnostic use
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Humans
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Magnetic Resonance Imaging
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Pericarditis/*diagnosis/*drug therapy/pathology
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Ventricular Dysfunction, Left/diagnosis/drug therapy/pathology
2.Takotsubo Cardiomyopathy: A Case of Persistent Apical Ballooning Complicated by an Apical Mural Thrombus.
Pil Hyung LEE ; Jae Kwan SONG ; In Keun PARK ; Byung Joo SUN ; Seung Geun LEE ; Ji Hye YIM ; Hyung Oh CHOI
The Korean Journal of Internal Medicine 2011;26(4):455-459
Takotsubo cardiomyopathy (TTC) is an infrequent cardiac syndrome characterized by acute onset chest pain with apical ballooning on echocardiography. It is often triggered by severe emotional or physical stress, and in contrast to acute myocardial infarction (AMI), the regional wall motion abnormality returns to normal within days. Here, we describe a 62-year-old female who presented with acute onset chest pain during treatment for a liver abscess. We presumed a diagnosis of AMI because of ST segment elevation on electrocardiography and elevated cardiac enzyme levels. However, the patient's coronary arteries were normal on angiography, and apical ballooning was seen on echocardiography. A diagnosis of TTC was made, and the patient was managed with intensive cardiopulmonary support using vasopressors in our hospital's medical intensive care unit. The patient's symptoms improved, but persistent severe left ventricular dysfunction was detected on follow-up echocardiography. After 5 weeks, a new apical mural thrombus appeared, and anticoagulation therapy was started. The apical ballooning persisted 3 months later, although the patient's overall ejection fraction was slightly improved. The apical thrombus was completely resolved without any embolic event. Non-adrenergic inotropics can be recommended in TTC with shock, and clinicians should keep in mind the potential risk of thrombus formation and cardioembolism.
Adrenergic beta-Antagonists/therapeutic use
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Angiotensin-Converting Enzyme Inhibitors/therapeutic use
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Catecholamines/blood
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Chest Pain
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Diuretics/therapeutic use
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Female
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Humans
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Middle Aged
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Takotsubo Cardiomyopathy/*diagnosis/drug therapy/pathology
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Thrombosis
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Ventricular Dysfunction, Left/diagnosis/drug therapy/pathology