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CBL- Hx of symptoms

CBL- Hx of symptoms. 34 year old Hispanic male presents with a chief complaint of chest pain. Sensation of left-sided chest pressure which becomes worse while lying down. Was healthy 10 days prior to admission.

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CBL- Hx of symptoms

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  1. CBL- Hx of symptoms • 34 year old Hispanic male presents with a chief complaint of chest pain. Sensation of left-sided chest pressure which becomes worse while lying down. • Was healthy 10 days prior to admission. • He had developed a severe sore throat, accompanied by a fever, rigors, and diffuse mylagias. • No associated cough, throat culture was negative for beta-hemolytic strep.

  2. CBL • Electrocardiogram revealed ~2mm ST segment elevations in II, III, aVF and V3-V6. • Initial troponin was 14.7 (normal levels are usually much lower). • Diagnosis of ST- elevation myocardial infarction was made and altephase was administered for thrombolysis. Also given- heparin, aspirin, clipidogrel, metopolol, simvastatin, and sublingual nitroglycerin. • Patient had temporary relief of chest pain, but recurred after a few hours. He was then transferred.

  3. CBL • Upon arrival the patient had a fever of 100.8 and still had persistent chest pain. • No dyspnea, palpitations, nausea, vomiting, or diaphoresis. • Diffuse PR segment depression and normal PR interval. • Had enlarged tonsils but no exudates, a single 0.5 cm tender left lymph node was palpable. • Cardiac exam revealed no murmurs, rubs, or gallops, and the PMI was non-displaced. • Pulmonary, musculoskeletal, dermatologic, and neurologic exams were all unremarkable.

  4. CBL • Any ideas as to the diagnosis at this point?

  5. CBL • Coronary arteries were angiographically normal. • Cardiac MRI was performed revealing inflammation of the myopericardium, decreased left ventricular systolic function, and no significant valvular regurgitation or lesions. • Mild mitral and tricuspid insufficiency.

  6. CBL- Laboratory Tests • Leukocyte count was remarkable at 27.6 • Troponin was 12.7 • A serum anti-streptolysin-O antibody was sent and returned as 1541 IU (normal <200) • Tests for echovirus, parvovirus, and coxsackle virus were all negative. • Hepatitis serologies and HIV testing were also negative. • TSH was normal at 1.9 • Epstein-Barr virus IgM was negative while IgG was positive. • Erythrocyte sedimentation rate was 48 (normal values range from 10-14) and the C-reactive protein (normally lower than 10) was 83. • Over the coarse of the hospital stay the patients ASO titer increased to 2982 IU (normal levels are < than 240).

  7. CBL • Over the coarse of the hospital stay the patients ASO titer increased to 2982 IU (normal levels are < than 240). • Indicates a strong infection by group A streptococcus, which is strongly associated with Acute Rheumatic Fever.

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