PMC8329507_01
EKG at Admission.. Initially in the ER, the EKG showed generalized ST-elevations as well as a right bundle branch block. There were no earlier EKG registrations available for comparison.
gr1.jpg
PMC8329507_01_gr1.jpg
fig0005
Due to the retrosternal chest pain, an EKG was performed in the ER which showed generalized ST-elevations as well as a right bundle branch block (Fig. 1).
Coronary Angiography at Admission.. The results of the coronary angiography showed no coronary artery obstruction.
gr2.jpg
PMC8329507_01_gr2.jpg
fig0010
The patient was rushed for a coronary angiography in order to rule out myocardial infarction (Fig. 2).
Laboratory development throughout the hospital stay.. The c-reactive protein (CRP), leukocytes and troponin T throughout the hospital stay. Laboratory values at admission were as follows: Creatinine: 220 mumol/L (ref<100). CRP: 435 mg/L (ref<5). Leukocytes: 14.5 109/L (ref:3.5-5.5). Troponin T: 172 ng/L (ref<5). Lactate: 5 mmol/L (ref<2.3).
gr3.jpg
PMC8329507_01_gr3.jpg
fig0015
Due to an increasing pericardial effusion causing early signs of cardiac tamponade (Fig. 3), the patient received a pericardiocentesis.
Transthoracic Echocardiograph.. A) At the cardiac intensive care unit there were signs of hemodynamic effects with a collapse of the right ventricle in diastole and collapse of the right atrium in systole. The pericardial effusion increased to about 2 cm. There was a high-echogenic structure suspicious for fibrin deposition. B) The pericardiocentesis resolved the hemodynamic instability. The pericardial effusion was culture negative for mycobacteria. Negative PCR for M. tuberculosis-complex-DNA but positive sequencing (16S) for Neisseria meningitidis DNA.. Blue arrow pointing towards pericardial effusion.
gr4.jpg
PMC8329507_01_gr4.jpg
fig0020
Fig. 4 illustrates how c-reactive protein (CRP), leukocytes and Troponin T varied over the course of the hospital stay.