PMC9353579_01
ECG images on the first day, the seventh day, and the 20th day of admission. (A) On the first day of admission, ECG showed sinus rhythm, right bundle branch block, and diffuse ST-segment elevation (red arrow). (B) On the seventh day of admission, ECG showed sinus rhythm and diffuse ST-segment elevation that improved significantly (red arrow). (C) On the 20th day of admission, ECG showed sinus rhythm with extensive anterior wall T-wave inversion (red arrow).
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F1
ECG showed: sinus rhythm, right bundle branch block, and ST-segment elevation in leads II, III, aVF, and V2-V6 (diffuse) (Figure 1A). ECG showed that sinus rhythm and diffuse ST-segment elevation were significantly improved (Figure 1B). ECG suggested sinus rhythm and ST-T changes (Figure 1C). Echocardiography indicated that the size of each cardiac cavity was normal, the movement of the ventricular wall was normal, and the ventricular systolic function was normal (LVEF = 59%) (Figures 2D-F).
Transthoracic echocardiography on the first day and the 18th day of admission. Chest X-ray and chest CT images on the first, eighth, and 15th day of admission. (A) On the first day of admission, the maximum anterior-posterior diameter of the posterior dark area of the left ventricular posterior wall on the long-axis view of transthoracic echocardiography was 0.8 cm (red arrow). (B) On the first day of admission, the maximum anterior-posterior diameter of the dark area of the lower wall of the left ventricle on the short-axis view of transthoracic echocardiography was 1.2 cm (red arrow). (C) On the first day of admission, transthoracic echocardiography showed that the anterior-posterior diameter of the dark area under the xiphoid process was 2.5 cm (red arrow). (D) On the 18th day after admission, the pericardial effusion on the long-axis view of transthoracic echocardiography was less than that before. (E) On the 18th day after admission, the pericardial effusion on the short-axis view of transthoracic echocardiography was less than that before. (F) On the 18th day of admission, transthoracic echocardiography four-chamber view. (G) On the first day of admission, a chest X-ray showed a few fibrous foci in both the lungs (red arrow). (H) On the eighth day of admission, the chest X-ray showed inflammation in the upper lobe of the left lung and the middle lobe of the right lung (red arrow). (I) On the 15th day of admission, the chest X-ray showed a little inflammation of the left upper lung (red arrow). (J) On the first day of admission, the cross-section of the chest CT soft-tissue window showed that the pericardial fat space was blurred and there was a large amount of pericardial effusion (red arrow). (K) On the eighth day of admission, the cross-section of the chest CT soft-tissue window showed bilateral pleural effusion with bilateral lower lung insufficiency (blue arrow) and a small amount of pericardial effusion (red arrow). (L) On the 15th day of admission, the cross-section of the chest CT soft-tissue window showed bilateral pleural effusion and bilateral lower lung insufficiency (blue arrow).
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F2
Transthoracic echocardiography showed pericardial effusion [the maximum anterior-posterior diameter of the posterior dark area of the left ventricular posterior wall was 0.8 cm (Figure 2A), the maximum anterior-posterior diameter of the dark area of the left ventricular inferior wall was 1.2 cm (Figure 2B), and the anterior-posterior diameter of the dark area of the xiphoid process was 2.5 cm (Figure 2C)] and the left ventricular systolic function decreased [left ventricular ejection fraction (LVEF) = 42%]. CT showed no abnormality. Chest CT showed a few fibrous foci in both the lungs (Figure 2G). Massive pericardial effusion and blurred pericardial fat space are also present, considering the possibility of inflammatory lesions (Figure 2J). CT showed no abnormality. Chest CT showed inflammation in the upper lobe of the left lung and the middle lobe of the right lung (Figure 2H), bilateral pleural effusion and bilateral lower lung insufflation (Figure 2K), and a small amount of pericardial effusion. ECG suggested sinus rhythm and ST-T changes (Figure 1C). Echocardiography indicated that the size of each cardiac cavity was normal, the movement of the ventricular wall was normal, and the ventricular systolic function was normal (LVEF = 59%) (Figures 2D-F). The patient's chest CT showed little inflammation in the upper left lung (Figure 2I), bilateral pleural effusion, and bilateral lower lung insufficiency (Figure 2L).
Clinical course of the patient during 21 days of hospitalization. Heart rate and body temperature changes. Daily liquid inflow and outflow. Use mechanical support therapy and medication.
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F3
His clinical course was as follows (Figure 3). The patient's body temperature was normal, the urine output also continued to increase, and the water balance gradually tended to be negative (Figure 3).
Changes of various indexes during 21 days of hospitalization. (A) cTnI. (B) NT-pro BNP. (C) ALT and AST. (D) Myocardial zymogram. (E) Platelet (PLT) and leukocyte count (WBC). (F) Total bilirubin (TBIL) and arterial blood gas lactate (Lac) levels. (G) Creatinine (Cr) and blood urea nitrogen (BUN). (H) Ejection fraction (EF) and average blood pressure (ABP) in transthoracic echocardiography.
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F4
Cardiac injury markers such as cTnI (Figure 4A), NT-proBNP (Figure 4B), and myocardial zymogram tended to improve (Figures 4C,D), leukocyte count (Figure 4E), liver function (Figure 4F), and renal function (Figure 4G). Echocardiography indicates gradual improvement of LVEF (Figure 4H) and the level of anaerobic metabolism in arterial blood decreased (pH 7.40, PaCO2 30 mm Hg, PaO2 77 mm Hg, HCO3- 18.6 mmol/l, BE- 5.4, and Lac 5.0 mmol/l). On the seventh day of admission, the patient's body temperature decreased and the level of anaerobic metabolism in arterial blood further decreased (pH 7.43, PaCO2 33 mm Hg, PaO2 90 mm Hg, HCO3- 21.9 mmol/l, BE- 1.9, and Lac 1.9 mmol/l), suggesting that organ perfusion was improved and relevant laboratory indexes tended to be improved (Figure 4).