PMC8720013_01
Electrocardiogram on presentation (a) showed sinus tachycardia (heart rate 111 beats per minute), ST elevations most prominent in leads V2-V3 with inferolateral T wave flattening. Baseline EKG (b) showing less prominent ST elevations in V2-V3 consistent with early repolarization without inferolateral T wave flattening.
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ST elevations most prominent in V2-V3 (Figure 1). Serum labs were notable for leukocytosis and elevated troponin, brain natriuretic peptide, and inflammatory markers (Table 1). Cardiac magnetic resonance (CMR) imaging showed global hypokinesis with a left ventricular (LV) ejection fraction (EF) of 45% (Figure S1) and subtle late gadolinium enhancement of the epicardial lateral wall and lateral pericardium with abnormal parametric mapping (Figure 2) consistent with myopericarditis.
Tissue characterization on presenting cardiac MRI. Subtle stripe of epicardial LGE noted in the lateral wall (a). The native T1 relaxation time is diffusely elevated throughout the myocardium (ULN for this 1.5 Tesla magnet is 1010 ms), suggestive of diffuse inflammation (b). The native T2 relaxation time is mildly elevated throughout the myocardium and highest in the inferior wall (ULN: 50 ms), suggestive of edema (c). Abbreviations: LGE: late gadolinium enhancement; ULN: upper limit of normal.
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Cardiac magnetic resonance (CMR) imaging showed global hypokinesis with a left ventricular (LV) ejection fraction (EF) of 45% (Figure S1) and subtle late gadolinium enhancement of the epicardial lateral wall and lateral pericardium with abnormal parametric mapping (Figure 2) consistent with myopericarditis.