Article Text

PDF
OC-49 Acute myocardial necrosis mimicking myocardial infarction in a duchenne disease case
  1. Eliza Cinteza,
  2. Claudiu Stoicescu,
  3. Niculina Butoianu,
  4. Alhareth Bassam,
  5. Dadiana-Safta Beschieru,
  6. Alin Nicolescu,
  7. Matthias Angres
  1. ”Marie Curie” Emergency Children’s Hospital, Bucharest, Romania; “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania

Abstract

Duchenne disease is known as a hereditary musculopathy which affects also the heart muscle. Related to the cardiomiopathy, almost all reports in literature describe a slow onset pattern for cardiac impairment and deterioration. Only exceptionally this can take an acute form. We present the case of an 11-year-old boy who was hospitalised for typical anginal retrosternal pain, nausea, vomiting and sweating, with the onset 12 hours prior to admission. The patient is known with progressive Duchenne muscular dystrophy since 2012, genetic diagnosis being confirmed in France and he was under treatment with prednisone and metoprolol.

Besides the clinical evolution, typical ECG changes were noted (inferior ST elevation, necrotic Q wave, QS wave in inferior and then lateral leads). Biological investigations performed on admission objectified: leukocytosis with increased neutrophils, slightly inflammatory syndrome (CRP 24.8 mg/L – then 42 mg/L on the 4thday from admission). LDH, AST, ALT, troponin T – up to 30 814 pg/ml (NV<14) – CK and CKMB were found elevated, suggestive of myocardial necrosis.

Echocardiography highlighted posterolateral myocardial wall hypokinesia, being consistent with the electrocardiographic changes of ST segment elevation in the inferior leads. Because of the severe onset mimicking an acute myocardial infarction, we had to perform a coronary angiogram. This showed normal epicardial coronary arteries. Myocarditis serology was negative. Cardiac MRI showed changes of myocardial fibrosis localised in the postero-inferior wall consistent with the ECG and echocardiography and absence of myocardial inflammatory modifications.

In the light of these changes, the dose of prednisone was increased to 60 mg/day, for 5 days, then returning to levels of 30 mg/day after reduction of the troponin about 10 times. Enalapril 1 mg/kg/day, furosemide (1 mg/kg/day) and spironolactone (1 mg/kg/day) were introduced into the treatment.

Conclusions In Duchenne muscular dystrophy cardiac changes generally take the appearance of dilated cardiomyopathy, but rarely can have acute character mimicking an acute myocardial infarction.

Statistics from Altmetric.com

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.