A case study myopericarditis

8/7/2019 A case study myopericarditis

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A case study

Dr. TO Hung Thuy

Dr. HO Anh BinhDr. NGUYEN Cuu Loi


2/24

Case history

A 22 years old man named Le Dinh K.

presented to the Emergency of Cardiology

Dept. with dyspnea and chest pain for 2 days

2 days before after drinking in the afternoon,

he felt tired at night and then dyspnea at rest

and continous and intense chest pain.

He first admitted to Quang Ngai provincial

hospital and the transfered to Hue CVC.


3/24

Chief complaint

Dyspnea at rest: progressively worsened

Tiredness

Chest pain: intense, sharp and continous pain,no specific radiation.


4/24

Past History

No prior history of any cardiovascular disease

No drug use

No family history of cardiac death


5/24

ECG on admission


6/24

ECG on admission


7/24

Documented cardiac enzymes at QNg Hospital

CK-MB : 185 ng/ml

TnT 3.2 ng/ml

TnI positiveWhat is the diagnosis ?

AMI

other diagnosis ?


8/24

2 D echo

Almost global hypokinesis

Small pericardial effusion

LV funtion compromises, EF 40%


9/24

Laboratory Findings

On arrival :

CK 3001 U/l

CK-MB : 185 ng/ml TnT 3.2 ng/ml


10/24

Laboratory Findings

Glucose 5.1 mmol/l

Urea 6.8 mmol/l

Creatinine 63 mol/l Cholesterol 2.55 mmol/l

HDL C 1.21 mmol/l

LDL C 0.94 mmol/l Triglyceride 0.88 mmol/l


11/24

Patient got worse

Anxious

Diaphoresis

Increased short of breath


12/24


13/24

8 hours later

CK 2474 U/l

CK-MB : 70.9 ng/ml

TnT 7.32 ng/ml CRP 77.6 mg/l

Diagnosis of myopericarditis reinforced

High dose of corticoids I.V Solumedrol 40 mg x6 vials ( 240 mg over 30 mins)


14/24

ECG 15 hours since admission


15/24

ECG 20 hours since admission


16/24

Dilemma

Question whether it is an AMI? PROS :

ST elevation evolution

Ongoing chest pain CONS: No Q wave occurred over time

PR depression

Concave ST elevation, but not clearprecordial

Second CRP( 17/1) 77.6 mg/l


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Coronary Angiogram


18/24

RCA Angiogram


19/24

Management

Stop Lovenox, Plavix, Aspegic

Drugs:

Heart failure

Digoxin mg half tabl a day

Dobutamin 3 g/kg/min

Lasix 20 mg x 2 IV

Imdur 60 mg half tabl a day Anti inflammation

Solumedrol 40 mg x 3 a day


20/24

Clinical Progress

Patient got better and better

Dyspnea resolved

chest pain disappeared in 3 days 5 days later (20/12/2010)

CK 112U/l

CK-MB : 2.67 ng/mlTnT 1.72 ng/ml

CRP 4.6 mg/l


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ECG on day 5


22/24

Echocardiography on day 5 ( 20/12/2010)

LV function normalized surprisingly and

dramatically LVEF = 60 %

LVEDd = 44 mm Systolic pulmonary artery pressure = 30

mmHg

No more pericardial


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Follow up

Patient was discharged in day 6

Follow up in 1 month (12/1/2011) No dyspnea on exertion

No chest pain

Good 6 min walk

Echo: LVEF 63 % LVEDd 43 mm


24/24

Thank you for your attention!

and discussion

Documents

A case study myopericarditis