Download An usual cardiac manifestation of a very common

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
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
Polymyalgia Rheumatica
Hypertension
Hyperlipidaemia
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
CMR
 Left ventricular function moderately impaired secondary to a
non-ischaemic cardiomyopathy
Within the mid ventricular region the contrast enhancement
was mid wall and in places transmural
Figure 5
Figure 5 and Figure 6
Endomyocardial biopsy,
cardiac myocytes replaced
with fibrosis (stained green
in lower picture).
Figure 6
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.