HC NTC 3.21.23 – “Shocking” ST Elevations

Today, R3 and future cardiology fellow Dr. Kevin Sung presented a case of an elderly man who presented with progressive dyspnea on exertion, chest pain, fevers, chills, and myalgias over the course of weeks to months who was referred from urgent care for ST elevations on EKG. Patient underwent cardiac catheterization and did not have any evidence of coronary artery disease or Takotsubo cardiomyopathy on ventriculogram. However, cardiac biomarkers and inflammatory markers were markedly elevated. In the cath lab, the patient had a markedly elevated PCWP, decreased CO/CI, and decreased MvO2, consistent with cardiogenic shock. An intra-aortic balloon pump was placed and dobutamine and diuresis were started and format TTE confirmed global LV dysfunction (EF 35%). Cardiac biopsy demonstrated myocarditis with giant cells and eosinophils. Patient was started on immunosuppression and GDMT with marked improvement (EF 48% prior to discharge). Thank you to cardiologist Dr. Torres Barba for being an excellent expert discussant for this case!

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