Hospital Course 1 (3/2021) Hospital Course 2 (9/2021)
Peak Troponin 1.207 ng/ml 128.44 ng/ml
Peak CK with CK-MB 100 U/L 3194 U/L
BNP 16 pg/ml 13.9 pg/ml
TSH / FT4 1.2 ng/dL / 6.62 IU/mL n/a
CRP 1.62mg/L 7.16mg/L
LFTs AST 15 U/L, ALT 13 U/L AST 251 U/L, ALT 50 U/L
Na / K / Cr / CO2 / Ca Within normal limits Within normal limits
ECG findings
NSR, Normal ECG PR 146, QTc 409 Sinus bradycardia with ‘incomplete RBBB’/Epsilon wave PR 142, QTc 392ms
Echo EF 55-60%. Normal LV size /systolic function without regional wall motion abnormalities. EF 40-45% with hypokinetic LV without wall motion abnormalities.
Cardiac MRI 6/21: LV has normal systolic function, (EF=55%) and normal cavitary size. There is normal wall thickness. There are no wall motion abnormalities. There is no evidence of myocardial fibrosis, infiltrative disease or arrhythmogenic right ventricular dysplasia. 9/2021: mildly reduced LV systolic function (EF=49%) with normal cavitary size/wall thickness but mild-mod hyperkinesis of the mid to apical lateral wall. There was prominent epicardial fibrosis of the basal anterior and entire lateral inferolateral, inferior, and anterolateral and lateral walls. There is small focal mid-myocardial fibrosis of the basal anterolateral wall and mid to apical infero-septal walls. There is sparring of the sub-endocardium with all scar patterns representing a non-ischemic pattern. There are elevated T1 and T2 values on mapping suggesting inflammatory or edematous component which is overlapping at areas of scar.
Normal Values:
Troponin: < 0.031ng/mL CK: 30-200 U/L BNP: <101.0 pg/mL TSH: 0.8 – 1.5 ng/dL FT4: 0.4 – 4.2 IU/mL CRP: <5.1 mg/L AST: <36 U/L ALT: <46 U/L
Appendix: ALT: Alanine Aminotransferase, AST: aspartate aminotransferase, BNP: Brain Natriuretic Peptide, Ca: Calcium, CK: Creatine Kinase, CK-MB: Creatine kinase-MB, CO2: Bicarbonate, Cr: Creatinine, CRP: C Reactive Protein, ECG: Electrocardiogram, EF: Ejection Fraction, FT4: Free Thyroxine, K: potassium, LV: Left ventricle, Na: Sodium, NSR: Normal sinus rhythm, RBBB: Right bundle branch block, TSH: Thyroid Stimulating Hormone Appendix: ALT: Alanine Aminotransferase, AST: aspartate aminotransferase, BNP: Brain Natriuretic Peptide, Ca: Calcium, CK: Creatine Kinase, CK-MB: Creatine kinase-MB, CO2: Bicarbonate, Cr: Creatinine, CRP: C Reactive Protein, ECG: Electrocardiogram, EF: Ejection Fraction, FT4: Free Thyroxine, K: potassium, LV: Left ventricle, Na: Sodium, NSR: Normal sinus rhythm, RBBB: Right bundle branch block, TSH: Thyroid Stimulating Hormone Appendix: ALT: Alanine Aminotransferase, AST: aspartate aminotransferase, BNP: Brain Natriuretic Peptide, Ca: Calcium, CK: Creatine Kinase, CK-MB: Creatine kinase-MB, CO2: Bicarbonate, Cr: Creatinine, CRP: C Reactive Protein, ECG: Electrocardiogram, EF: Ejection Fraction, FT4: Free Thyroxine, K: potassium, LV: Left ventricle, Na: Sodium, NSR: Normal sinus rhythm, RBBB: Right bundle branch block, TSH: Thyroid Stimulating Hormone