Chatzantonis Grigorios, Meier Claudia, Bietenbeck Michael, Rueckert Jan, Dorsel Thomas, Yilmaz Ali, Florian Anca
Division of Cardiovascular Imaging, Department of Cardiology I, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149 Münster, Germany.
Department of Cardiology and Angiology, Josephs-Hospital Warendorf, Am Krankenhaus 2, 48231 Warendorf, Germany.
Eur Heart J Case Rep. 2020 Feb 17;4(2):1-6. doi: 10.1093/ehjcr/ytaa017. eCollection 2020 Apr.
Streptococcal pharyngitis is a common infection, with both suppurative and non-suppurative complications. Most importantly, a streptococcal infection can cause heart disease in different pathophysiological pathways. Acute non-rheumatic perimyocarditis appears to be a more frequent pathological entity associated with streptococcal pharyngitis as once thought, which is poorly understood and explored.
We present the case of a middle-aged man with acute chest pain, electrocardiogram (ECG) abnormalities, and elevated cardiac enzymes following a recent episode of pharyngitis in which streptococcal-associated perimyocarditis was diagnosed. Cardiovascular magnetic resonance (CMR) imaging established the diagnosis and allowed cardiac disease monitoring after successful antibiotic therapy resulting in complete clinical recovery.
Patients presenting with acute chest pain, ECG abnormalities, and cardiac enzyme elevations do not always suffer from an ischaemic heart attack. A thorough investigation comprising a detailed past medical history and non-invasive imaging such as CMR are the cornerstones for unravelling a correct diagnosis and implementing a proper treatment-as was shown in the present clinical case.
链球菌性咽炎是一种常见感染，可引发化脓性和非化脓性并发症。最重要的是，链球菌感染可通过不同的病理生理途径导致心脏病。急性非风湿性心包心肌炎似乎是一种比以往认为的更常见的与链球菌性咽炎相关的病理实体，目前对其了解和研究较少。
我们报告了一例中年男性病例，该患者近期患咽炎后出现急性胸痛、心电图（ECG）异常及心肌酶升高，诊断为链球菌相关性心包心肌炎。心血管磁共振（CMR）成像确诊了该病，并在成功进行抗生素治疗后实现临床完全康复的过程中对心脏疾病进行了监测。
出现急性胸痛、ECG异常及心肌酶升高的患者并不一定患有缺血性心脏病发作。全面的调查，包括详细的既往病史和如CMR等非侵入性成像检查，是明确正确诊断并实施恰当治疗的基石——本临床病例即展示了这一点。
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