Introduction
53 years old female patient, who
presented oppressive precordial pain, radiating to the neck and jaw, for which
she went to the emergency room, where an ECG image of complete left bundle
branch block was evidenced (Figure 1), with taking ultrasensitive troponin I at
> 50,000 pg/ml, presenting data of acute heart failure and acute pulmonary
edema, requiring endotracheal intubation, moving urgently to cardiac
catheterization without evidence of obstructive coronary lesions, observing in
aortography interruption of the aortic arch with collateral vessels connecting
to the descending aorta (Figure 2). Later in the ICU, an echocardiogram was
performed that reported LVEF of 27%, generalized hypokinesia, severe MI and
apical thrombus (Figure 3), diagnosing fulminant myocarditis, for which
treatment with methylprednisolone at a dose of 500 mg for 3 days was started.
presenting improvement with LVEF of 35%, however, she later presented septic
shock of pulmonary origin, which led to the death of the patient. Aortic arch
interruption is a congenital malformation characterized by complete
interruption between the ascending and descending aorta, with 3 types according
to the Celoria-Patton classification, B being the most frequent, while
fulminant myocarditis is myocardial inflammation due to various etiologies ,
mainly viral, which can present from a picture of acute heart failure to
cardiogenic shock and can simulate a picture of acute coronary syndrome. The
importance of the previous case resides in the fact that, although there is no
association between both pathologies, there is no case reported in the
literature in which they occur simultaneously.
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