Before the first hospitalization, the patient reported symptoms of: paroxysmal nocturnal dyspnea, orthopnea and dyspnea on exertion.
During the first hospitalization, flecainide was discontinued and warfarin and metoprolol were started. She ruled out for an acute myocardial infarction and a dipyridamole thallium study did not demonstrate ischemia. An echo-cardiogram revealed normal left ventricular function and a mildly enlarged left atrium.
Two weeks prior to her second hospitalization, the patient experienced the sudden onset of: fatigue, decreased endurance, irregular heart beat, constant chest pressure and profound dyspnea on exertion.
Prior to this illness, the patient could ambulate for thirty minutes without fatigue or dyspnea. On the day of consultation she experienced dyspnea on walking 20 yards.
Review of Symptoms: Positive for: 10 pound weight gain, diffuse chronic myalgias, and anxiety
The Patient Has a Pathologic Process Involving the Pericardium and Myocardium that is Not Related to Valvular or Ischemic Disease. Additionally, Noted is an Echocardiogram Demonstrating Highly Abnormal Left Atrial Walls.
Lymphocytic Myocarditis: Most Will Improve Over 1-6 Months, a Minority Will Fail to Clear a Cardiotropic Virus or Develop Persistent Inflammation That Leads to Chronic Cardiomyopathy, Heart Block or Ventricular Arrhythmias.
Myocarditis Treatment Trial: Prospective Randomized, Double-Blind, Placebo-Controlled Trial of Prednisone and Cyclosporine or Azathioprine for the Treatment of Biopsy Proven Lymphocytic Myocarditis in Acute CHF. There Was No Benefit from Immunosuppression.
Immune Modulation for Acute Cardiomyopathy: Evaluated the Role of IVIG and Found no Benefit.
EKG: Often Have Bundle Branch Block, Low Voltage Despite Thick Ventricles, or A-Fib
Most Patients with Amyloidosis, Even Those with no Cardiac Symptoms, Have Abnormal Echocardiograms with: Ventricular Wall Thickening (70%), Isolated Septal Wall Thickening (30%), Diastolic Dysfunction (57%), Systolic Dysfunction (27%), Pericardial Effusion (40%), Myocardial Sparkling Pattern in 2D (27%)
Diagnosed by Endomyocardial Biopsy Demonstrating: Diffuse Myocardial Necrosis with Multinucleated Giant Cells in the Absence of Sarcoid Like Granuloma. Inflammatory Infiltrate in Close Apposition to Myocyte Necrosis. Negative Culture and Stains for Infection, No Viral Particles on Electron Microscopy.