Key result
After one month of medical therapy including beta-blockers and ACE inhibitors, the patient's ejection fraction improved from 30% to 63% with normal left ventricular function.
Case Report (n=1)
This case highlights the utility of cardiac MRI in diagnosing acute myocarditis in patients presenting with troponin-positive chest pain and unobstructed coronary arteries, and demonstrates rapid recovery of left ventricular function with guideline-directed medical therapy.
Case of troponin-positive chest pain with normal ECG in a young adult warrants broad differential; leaves open need for systematic study of similar presentations.
We present a 29-year-old man who presented with crushing substernal chest pain with radiation to his jaw and associated diaphoresis. He was hemodynamically stable and electrocardiogram was unremarkable. Laboratory studies revealed initial high-sensitivity troponin of 1950 ng/L (reference: <15 ng/L), 2-hour troponin 2165 ng/L, and 6-hour troponin 2413 ng/L. NT-pro-BNP was elevated at 1692 pg/mL (reference: <51 pg/mL), and C-reactive protein was 50.9 mg/L (reference: <8 mg/L). Transthoracic echocardiogram revealed an ejection fraction (EF) of 30% with severe global left ventricular hypokinesia. Left heart catheterization revealed normal coronary arteries. Cardiac magnetic resonance imaging showed acute myocarditis. With aggressive diuresis and anti-inflammatory therapy for concomitant pericarditis, his symptoms improved. After one month of beta-blocker and angiotensin converting enzyme inhibitor therapy, his EF improved to 63% with normal left ventricular function.
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Padkins et al. (2020) conducted a case report in Acute myocarditis (n=1). Diuresis, anti-inflammatory therapy, beta-blocker, and ACE inhibitor was evaluated on Ejection fraction and symptom improvement. After one month of medical therapy including beta-blockers and ACE inhibitors, the patient's ejection fraction improved from 30% to 63% with normal left ventricular function.
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