key: cord-0686538-qrqcda6m
authors: Sharrack, Noor; Poenar, Ana-Maria; Simms, Alexander D.; Greenwood, John P.; Plein, Sven
title: Acute Myocarditis Mimicking Hypertrophic Cardiomyopathy in Marfan Syndrome and Morphologically Abnormal Mitral Valve
date: 2022-01-19
journal: JACC Case Rep
DOI: 10.1016/j.jaccas.2021.11.023
sha: 139d51267d396b19462c947ddb70c4e24b12d158
doc_id: 686538
cord_uid: qrqcda6m

A 40-year-old man with Marfan syndrome presented with chest pain and troponin elevation. Urgent echocardiography was suggestive of hypertrophic cardiomyopathy, but cardiovascular magnetic resonance identified features of acute myocarditis. Repeated imaging 4 months later showed resolution of septal thickness, confirming acute myocarditis. (Level of Difficulty: Intermediate.)

Blood studies revealed a lymphocytosis of 12.21 Â 10 9 /L (reference range 4-11 Â 10 9 /L) and elevated C-reactive protein 218 mg/L (reference range <10 mg/L), with negative blood cultures. High-sensitivity troponin I was elevated at 1,405 ng/L (reference range <57 ng/L). The results of both D-dimer and

To underline the role of multimodality imaging in complex cases where there is diagnostic uncertainty. To revisit the central role of cardiovascular magnetic resonance in the diagnosis of myocarditis.

To highlight the importance of serial imaging in confirming a correct diagnosis. The CMR findings raised the suspicion of acute myocarditis. The asymmetric septal hypertrophy was assumed to be caused by acute edema rather than by HCM. Follow-up CMR was requested to confirm the final diagnosis.

Initial management included dual antiplatelet therapy and fondaparinux for presumed acute coronary syndrome, which were quickly discontinued after normal coronary angiography results. Intravenous diuretic agents and continuous positive airway 

The patient was followed up in the cardiology clinic 6 weeks after discharge. Interval CMR imaging 4 months later showed significant reduction in the 

The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Dr. Noor 

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FIGURE 7 Cardiac Magnetic Resonance Short-Axis Cine Slices With Septal Measurements Left ventricular septal wall thickness at scan 1 (11 mm), scan 2 (17 mm

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An unusual cause of left ventricular hypertrophy