Myocardial infarction mimicry; if it glitters, it may not be gold!

Mohd Shah, Azarisman Shah and Abdullah, Aszrin (2024) Myocardial infarction mimicry; if it glitters, it may not be gold! Medicine and Health Journal, 19 (5). p. 72. ISSN 1823-2140 E-ISSN 2289-5728

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Abstract

Introduction: A 30-year-old male, no apparent risk factors apart from chronic smoking, presented with a 2-week history of intermittent chest pain and progressive dyspnoea. Further history elucidated ostensible orthopnoea and paroxysmal nocturnal dyspnoea. Clinical examination revealed elevated jugular venous pressure, displaced apex beat, bibasal crepitations and bilateral pedal oedema. Electrocardiogram showed right bundle branch block, chest X-ray revealed globular cardiomegaly with pulmonary venous congestion and Troponin T was elevated – 100 pg/mL. Clinically, it was apparent that the patient had underlying non-ST elevation myocardial infarction complicated by congestive cardiac failure. Echocardiogram showed dilated ventricles and prominent trabeculations with an ejection fraction of only 25%. This prompted a cardiac MRI examination which revealed an appearance of prominent trabeculations and deep recesses in the left ventricle but no apparent segmental thickening of the left ventricular myocardial wall. Furthermore, the right ventricle appears to have complete absence of apical trabeculations. In summary, the cardiac MRI seemed to suggest left ventricular non-compaction but the anatomical criteria were not completely met and there were several anomalies. A cardiac CT examination was then ordered which finally revealed the underlying pathology - congenitally corrected transposition of the great arteries with failing systemic right ventricle resulting in the current clinical presentation as congestive cardiac failure. Coronary angiography revealed no significantly obstructive coronary artery disease aside from the usual anomalies associated with congenitally corrected transposition of the great arteries. Conclusion: Whenever a patient presents with a clinically apparent myocardial infarction and congestive cardiac failure, always be aware of the great multitude of mimics that may present similarly. Always undertake the same rigorous investigative pursuit of all patients presenting likewise. This is to ensure that patients are appropriately diagnosed and safely managed once the underlying pathology has been established.

Item Type:	Article (Abstract)
Uncontrolled Keywords:	myocardial infarction, transposition of the great arteries.
Subjects:	R Medicine > R Medicine (General) R Medicine > RB Pathology R Medicine > RC Internal medicine R Medicine > RC Internal medicine > RC66 Clinical cases R Medicine > RC Internal medicine > RC667 Specialties of Internal Medicine-Diseases of Circulatory (Cardiovascular) System
Kulliyyahs/Centres/Divisions/Institutes (Can select more than one option. Press CONTROL button):	Kulliyyah of Medicine > Department of Basic Medical Kulliyyah of Medicine
Depositing User:	DR Aszrin Abdullah
Date Deposited:	26 Jan 2025 14:42
Last Modified:	26 Jan 2025 14:42
URI:	http://irep.iium.edu.my/id/eprint/118886

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