Tran Nam, Kwok Chun Shing, Bennett Sadie, Ratib Karim, Heatlie Grant, Phan Thanh
University Hospitals of North Midlands NHS Trust, Cardiology, Stoke-on-Trent, UK.
University Hospitals of North Midlands, Department of Cardiology, Stoke-on-Trent, UK.
Echo Res Pract. 2020 Jan 9;7(1):K1-K6. doi: 10.1530/ERP-19-0044. eCollection 2020 Mar.
A 62-year-old female was admitted with severe left-sided chest pain, nausea and pre-syncope. She had widespread T wave inversion on ECG and elevated troponins and was suspected to have an acute coronary syndrome event. Invasive coronary angiogram revealed normal coronary anatomy with no flow-limiting lesions. Echocardiography and cardiac MRI revealed impaired left ventricular (LV) systolic impairment, a mobile LV apical thrombus and a moderate global pericardial effusion with no significant compromise. Full blood count analysis indicated the patient to have significant eosinophilia, and the patient was diagnosed with idiopathic eosinophilic myocarditis. She was commenced on Prednisolone and Apixaban, and eosinophil levels returned to normal after 10 days of steroids. Over the course of 3 months, the patient had a complete recovery of her LV function and resolution of the LV thrombus. This case highlights a rare, reversible case of idiopathic eosinophilic myocarditis which may present similar to acute coronary syndrome.
Eosinophilic myocarditis (EM) is a rare disease that can exhibit symptoms similar to acute coronary syndrome events.The diagnosis of EM should be considered in patients with chest pain, normal coronary angiogram and pronounced eosinophilia levels.Endomyocardial biopsy is the gold standard diagnostic tool; however, it has a low sensitivity detection rate and its use is not indicated in some patients.Echocardiography is useful in the initial detection of cardiac involvement and complications. However, echocardiography lacks diagnostic specificity for all forms of myocarditis including EM.Cardiac magnetic resonance is a useful method and may add in diagnosing all forms of myocarditis including EM.Patients with EM should be identified promptly and treated with high doses of oral glucocorticoid to reduce the risk of permanent cardiac dysfunction.
一名62岁女性因严重左侧胸痛、恶心和晕厥前期入院。她的心电图显示广泛T波倒置，肌钙蛋白升高，怀疑发生急性冠状动脉综合征事件。有创冠状动脉造影显示冠状动脉解剖结构正常，无血流限制性病变。超声心动图和心脏磁共振成像显示左心室（LV）收缩功能受损，左心室心尖部有活动血栓，中度心包积液，无明显心脏功能受损。全血细胞计数分析表明患者有明显嗜酸性粒细胞增多，该患者被诊断为特发性嗜酸性粒细胞性心肌炎。她开始使用泼尼松龙和阿哌沙班治疗，使用类固醇10天后嗜酸性粒细胞水平恢复正常。在3个月的病程中，患者左心室功能完全恢复，左心室血栓消失。该病例突出了一例罕见的、可逆转的特发性嗜酸性粒细胞性心肌炎，其表现可能与急性冠状动脉综合征相似。
嗜酸性粒细胞性心肌炎（EM）是一种罕见疾病，可表现出与急性冠状动脉综合征事件相似的症状。对于胸痛、冠状动脉造影正常且嗜酸性粒细胞水平明显升高的患者，应考虑EM的诊断。心内膜心肌活检是金标准诊断工具；然而，其检测敏感性较低，在某些患者中不建议使用。超声心动图有助于初步检测心脏受累及并发症。然而，超声心动图对包括EM在内的所有形式心肌炎缺乏诊断特异性。心脏磁共振成像（CMR）是一种有用的方法，可能有助于诊断包括EM在内的所有形式心肌炎。应及时识别EM患者，并给予高剂量口服糖皮质激素治疗，以降低永久性心脏功能障碍的风险。
