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07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
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21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
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26. Cardiovascular Surgery
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28. Risk Factors and Prevention
29. Rehabilitation and Sports Cardiology
30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
33. e-Cardiology / Digital Health
34. Public Health and Health Economics
35. Research Methodology
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Abstract
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CLEAR FILTERS
A Rare Case of Myocarditis
Session:
Sessão Speaker's Corner - Casos clínicos desafiantes… em Insuficiência Cardíaca
Speaker:
Tânia Proença
Congress:
CPC 2022
Topic:
D. Heart Failure
Theme:
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Subtheme:
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Session Type:
Sessão de Casos Clínicos
FP Number:
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Authors:
Tânia Proença; Ricardo Alves Pinto; Miguel Martins Carvalho; Alzira Nunes; Catarina Costa; Filipa Amador; João Calvão; Catarina Marques; André Cabrita; Cátia Oliveira; Ana Pinho; Luís Santos; Paula Dias; Filipe Macedo
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:"Calibri",sans-serif">A 43-year-old female without cardiovascular risk factors was evaluated at emergency department due to <em>de novo </em>dyspnoea and peripherical oedema; she was hemodynamically stable, tachycardic, with jugular vein distention, normal cardiac auscultation, pulmonary congestion and peripheral oedema. ECG revealed sinus tachycardia (120 bpm), and low voltage precordial leads. Blood test showed eosinophilia (3.3 x 10<sup>9</sup>/L), high C-reactive protein (138 mg/L) and elevated high-sensitivity troponin I (4 500 ng/L). Echocardiography revealed normal volume cardiac chambers with left ventricular (LV) hypertrophy, moderate-to-severe LV dysfunction with global hypokinesia, right systolic ventricular dysfunction and moderate mitral regurgitation. The patient evolved with cardiogenic shock requiring inotropic support. Eosinophilic myocarditis was suspected, so an endomyocardial biopsy was performed and corticosteroid therapy was started. Due to refractory cardiogenic shock and electrical storm (recurrent sustained ventricular tachycardia (VT) with hemodynamically instability and ventricular fibrillation (VF) with cardiac arrest), arteriovenous extracorporeal membrane oxygenation (VA-ECMO) was initiated. Biopsy result confirmed eosinophilic myocarditis and corticotherapy was maintained. Two weeks later, she presented pericardial effusion needing pericardiocentesis and surgical drainage. Three weeks after VA-ECMO, she was decannulated thanks to clinical improvement and eosinophilia resolution. An echocardiography revealed normal volume and thickness cardiac chambers and preserved biventricular function. Secondary causes of eosinophilia have been ruled out, so a final diagnosis of Idiopathic Eosinophilic Myocarditis was made.</span></span></p>
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