Year: 2020
Type: article
Study design: Case Report
Abstract: ECG CHALLENGEA 45-year-old female with no significant past medical history developed progressive fatigue and dyspnea.Echocardiogram showed a left ventricular ejection fraction of 25% to 30%, moderate dysfunction of right ventricle, and dilated atria.Pro-B-type natriuretic peptide (proBNP) was elevated.Her ECG was considered to show paroxysmal atrial tachycardia and possible atrial fibrillation (Figure 1A).Holter monitor was read as having frequent atrial tachycardia runs.Cardiac MRI, stress test, left heart catheterization, and positron emission tomography were all negative for inflammation, infiltration, and coronary artery disease.Thyroid function was normal.She was started on medical therapy with carvedilol, losartan, and spironolactone.Left ventricular function did not improve significantly.She underwent an electrophysiology study, but no arrhythmia could be induced, and frequent junctional beats were reported.An implantable cardioverter defibrillator was inserted for primary prevention of sudden cardiac death.An endomyocardial biopsy was performed 9 months after diagnosis and showed eosinophilic infiltrate in 1 of 4 specimens obtained.There was no peripheral eosinophilia or evidence of hypereosinophilic syndrome in any other organ system.She was started on azathioprine and prednisolone.Despite an additional 7 months of immunosuppressive therapy and continuation of standard heart failure medications her ejection fraction did not improve.She continued to have frequent premature beats and runs.She was referred for further evaluation of premature beats.An ECG was done (Figure 1B).What is the diagnosis?Please turn the page to read the diagnosis.
Source: Circulation
Institutions: University of Cincinnati, Sisters of Mercy Health System
Language: English
Subfield: Rheumatology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W3010341644