Mosebach Christian M, Tandon Varun, Kumar Manish
Internal Medicine, University of Connecticut Health Center, Farmington, USA.
Internal Medicine, University of Arizona College of Medicine - Phoenix, Phoenix, USA.
Cureus. 2019 Jul 23;11(7):e5212. doi: 10.7759/cureus.5212.
A 50-year-old male presented to the hospital with an approximate three-week history of nausea, fever, and back pain. Upon initial evaluation he had an electrocardiogram with ischemic changes and initial labs significant for a troponin of >25.0 ng/ml (<0.30 ng/ml), pro b-type natriuretic peptide (proBNP) of 9884 pg/ml (<125 pg/ml), and a lactic acid of 4.3 mmol/L (0.5-1.9 mmol/L). There was a concern for an acute coronary syndrome presenting as cardiogenic shock, but the patient was unable to tolerate left heart catheterization. He had a rapid clinical decline and despite all efforts, he passed away. The initial cause of death was thought to be due to an acute myocardial infarction, however, autopsy results were consistent with acute myocarditis. This case highlights the presentation of acute myocarditis as an acute coronary syndrome with complete heart block.
一名50岁男性因恶心、发热和背痛约三周的病史入院。初步评估时，他的心电图有缺血性改变，初始实验室检查显示肌钙蛋白>25.0 ng/ml（<0.30 ng/ml）、脑钠肽前体（proBNP）为9884 pg/ml（<125 pg/ml）、乳酸为4.3 mmol/L（0.5 - 1.9 mmol/L）。患者被怀疑患有表现为心源性休克的急性冠状动脉综合征，但无法耐受左心导管插入术。他的临床状况迅速恶化，尽管全力抢救，最终还是去世了。最初认为死因是急性心肌梗死，然而，尸检结果与急性心肌炎相符。该病例突出了急性心肌炎表现为伴有完全性心脏传导阻滞的急性冠状动脉综合征。
