Myocardial infarction in a teenager
Bibliographic record
Abstract
An 18-year-old male presented to the Emergency Department with a 3-h history of chest pain. On physical examination, he had a blood pressure of 150/95 mmHg, mild obesity, and otherwise normal examination. An electrocardiogram showed sinus rhythm with short PR interval, ventricular preexcitation, and non-specific repolarization abnormalities (Panel A). There was a mild peak troponin elevation (3.2 μg/L). Cardiac catheterization showed normal coronary arteries. An echocardiogram showed massive hypertrophy of the left ventricle (LV) (Panel B). One week later a cardiac magnetic resonance with delayed contrast enhancement imaging showed localized gadolinium uptake in the interventricular septum, consistent with a myocardium infarction (arrows, Panel C). An LV septal thickness was 44 mm. A fasciculoventricular pathway was diagnosed at electrophysiological study. An endomyocardial biopsy was performed and the anatomical pathology revealed myocite vacuolization consistent with a storage disease, preserved myocite architecture, and absence of inflammation and fibrosis (Panels D and E). Genetic analysis identified a PRKAG2 gene mutation (R302Q). PRKAG2 cardiac syndrome causes a cardiomyopathy due to glycogen storage which may mimic classic hypertrophic cardiomyopathy. It is important to correctly differentiate between these entities because prognosis and treatment are different. We speculate the patient’s acute septal infarct resulted from a demand–supply mismatch of a severely hypertrophied septum, which has not been previously reported in storage diseases of the myocardium.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".