PMC5529618_01
12 lead ECG upon admission to our center.
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fig1
Arterial blood gas analysis showed serum lactate of 3.7 mmol/l and elevated transaminases (GOT 2624 (0-35) U/l, GPT 2234 (0-35) U/l), cardiac markers (creatine kinase 1730 (0-145) U/l, high sensitive troponin-I 93430 (0-26) pg/ml) were significantly elevated, with no signs of acute myocardial infarction in the ECG (Figure 1).
Monitor recording of episode of sudden cardiac arrest.
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fig2
The patient suffered cardiac arrest (Figure 2) and was treated with catecholamines as well as a calcium sensitizer (Levosimendan, Simdax , Orion Corporation, Espoo, Finland), but for stabilization an Impella CP (Abiomed Inc., Danvers, MA, USA) was necessary (Figure 3).
Impella CP Monitor. Impella CP Monitor at initial stage (a); Impella CP Monitor at advanced stage (b).
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fig3
The patient suffered cardiac arrest (Figure 2) and was treated with catecholamines as well as a calcium sensitizer (Levosimendan, Simdax , Orion Corporation, Espoo, Finland), but for stabilization an Impella CP (Abiomed Inc., Danvers, MA, USA) was necessary (Figure 3).
Endomyocardial biopsy. Histological detection of massive infiltration by mononuclear inflammatory cells: (a) overview section (50x); (b) cluster infiltrated immunocompetent cells (purple, 400x), myocardial damage; (c) MHCII-overexpressing immunocompetent cells (esp. macrophages, 200x); and (d) CD3-T-lymphocytes (brown 200x).
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fig4
Immunohistology detected numerous CD3-positive T-lymphocytes and a number of CD68-positive and MHCII-overexpressing macrophages (Figure 4).