Myocarditis, Typhoid

Dull

Step 1: View clinicals

A 33 year old man presents with constant, dull retrosternal pain for 6 hours, which radiates to the left shoulder, is worsened by exertion, and is associated with dyspnea. He had watery diarrhea since today. The week before, he had returned from a family holiday in Brazil. His father developed diarrhea 5 days ago, and is being treated for typhoid infection. A chest x-ray is found to be normal, but serial ECGs show upwardly convex ST elevations in the leads V1-V6, I and AvL.


Step 2: Order all relevant investigations

Angiography

Coronary angiography shows a pristine coronary vasculature.

Troponin-I

The Troponin-I is 0.2 ng/ml (normal: <0.1)

Echocardiogram

There are hypokinetic areas in the anterior and lateral walls, showing jerky movements. The left ventricle is mildly dilated, with an ejection fraction of 45%. There are no other structural or valvular defects; no vegetations are seen.

Blood and Stool Cultures

Blood and stool samples are sent for culture; reports will be available in 48 to 72 hours.


Step 3: Select appropriate management

DVT Prophylaxis
IV Antibiotics
Thrombolysis
ACE Inhibitors


Score: ★★☆