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An usual cardiac manifestation of a very common systemic inflammatory condition

An usual cardiac manifestation of a very common systemic inflammatory condition. Tweedie J 1 , Roberts MJ 1 , Herron B 1 , Sheppard M 2 , McClements B 3 .

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An usual cardiac manifestation of a very common systemic inflammatory condition

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  1. An usual cardiac manifestation of a very common systemic inflammatory condition Tweedie J1, Roberts MJ1, Herron B1, Sheppard M2, McClements B3. 1 Royal Victoria Hospital, Grosvenor Road, Belfast. 2. National Heart and Lung Institute, Imperial College London. 3. Mater Infirmary Hospital, Crumlin Road Belfast

  2. Presenting complaint • A 69 year old lady presents to the primary percutaneous intervention service (PPCI) with central crushing chest pain. ECG demonstrates right bundle branch block • Angiographically normal coronary arteries and mild left ventricular impairment. • Represents seven months later with generalised fatigue, chest pain and muscle ache PMH PolymyalgiaRheumatica Hypertension Hyperlipidaemia

  3. Hospital Course • Clincial examination unremarkable • ECG – junctional bradycardia and right bundle branch block • NT Pro-BNP significantly elevated at 2051 • Echocardiography – moderate left ventricular impairment • Cardiomyopathy bloods negative • Beta-blocker discontinued • Class III NYHA

  4. CMR • Left ventricular function moderately impaired secondary to a non-ischaemic cardiomyopathy

  5. Within the mid ventricular region the contrast enhancement was mid wall and in places transmural

  6. Figure 5 Figure 5 and Figure 6 Endomyocardial biopsy, cardiac myocytes replaced with fibrosis (stained green in lower picture). Figure 6

  7. Conclusion • Diagnosis of left ventricular systolic impairment secondary to PMR was made. • The patient was commenced on high dose oral glucocorticosteroid and remains under review. • A previous case report describes resolution of CMR findings and left ventricular dysfunction six months after commencing oral corticosteroid therapy3, follow-up CMR is awaited. • This case highlights the importance of considering systemic causes of LV dysfunction even when an association is not well recognised.

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