PMC8633440_01
(A) Initial ECG at the emergency room showed poor R wave progression on precordial lead and QS wave on anterior and inferior leads. (B) Follow-up ECG after 3-month therapy showed increased R wave amplitude in inferior leads. (C,D) Coronary angiography demonstrates normal coronary arteries; (C) Right coronary artery. (D) Left coronary arteries.
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F1
In the emergency department, his electrocardiogram (ECG) showed acute myocardial infarction (Figure 1A). Considering it had been more than 12 h since the onset, coronary angiography (CAG) was not performed until Day 7, showing normal coronary arteries (Figures 1C,D). ECG showed that the R wave amplitudes in lead II and avF increased significantly compared with those at the onset of MINOCA (Figure 1B).
(A,B) After comprehensive treatment, the white blood cells (WBC), eosinophilia (EO), CRP, IgG, IgG4, and IgE responded rapidly and kept dropping down. (C) Chest CT indicated multiple lung infiltrates and small patches of ground-glass appearance in both lungs initially. (D) After half-a-month antibiotic therapy, the lung infiltration infiltrates obviously disappeared.
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F2
Chest CT indicated multiple lung infiltrates and small patches of ground-glass appearance in both lungs (Figure 2C). Anti-neutrophil cytoplasmic antibody was negative, while IgG and IgG4 were markedly elevated (19.10, 6.700 g/L, respectively normal: 10.13-15.13, <= 2.00 g/L, respectively) (Figures 2A,B). After being diagnosed as EGPA, the patient started on intravenous methylprednisolone (40 mg/day), and his eosinophil count, CRP, IgG, IgG4, and IgE returned to normal within 1 week (Figures 2A,B), and the lung infiltrates obviously disappeared (Figure 2D).
Cardiac magnetic resonance (CMR) imaging at the baseline (A-D) and after 3-month prednisone and immunosuppressant therapy (E-H). T2-weighted image (A) demonstrated small patches of high-signal intensity in mid-wall and subendocardial regions of the interventricular septum, revealing myocardial edema. On the four-chambered (B) and basal short-axis (C) view of late gadolinium enhancement (LGE), multiple foci of high-signal intensity were scattered diffusely in mid-wall and subendocardial regions in a nonischemic pattern. An extracellular volume (ECV) map (D) showed heterogeneously elevated ECV fraction of the left ventricular myocardium and septum; the global ECV fraction was 34.6%. On posttreatment CMR, it showed complete remission of the myocardial edema (E) and significantly reduced LGE (F,G). The global ECV fraction decreased to 29.6% (H).
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F3
Cardiac magnetic resonance imaging (CMR) showed normal wall motion with inflammatory edema (Figure 3A), and late gadolinium enhancement (LGE) was found in multiple foci (Figures 3B-D). CMR showed regression of edema (Figure 3E) and significant resolutions of myocardial fibrosis (Figures 3F-H).