PERICARDITIS - MYOCARDITIS - ENDOCARDITIS
Bibliographic record
Abstract
Acute myocarditis is an important differential diagnosis of acute coronary syndrome.In the present case report we show the importance of the integration of different diagnostic tools in the work up of acute myocarditis focusing in particular on the etiological diagnosis.A.Z is a 53 years old patients coming at our attention in the emergency department for the sudden onset of dyspnea (functional class NYHA III/IV) and constrictive chest pain during mild efforts.The patients hystory was silent.The only cardiovascular risk factor was smoking (1 pack per day).The initial ECG showed: sinus rythm, a right bundle branch block (RBBB) with aspecific alterations of ST and T. The high sensitivity troponin I (TnI HS) was augmented (> 95.000 pg/ml; normal values < 32 pg/ml) and also c-reactive protein (PCR ¼ 1.2 pg/ml).The echocardiographic examination showed a diffuse and mild reduction of systolic function and a moderate mitral regurgitation.The patients was admitted in the coronary intensive care unit (ICU) with the working diagnosis of acute coronary syndrome (ACS).In the first day of admission a coronary angiography was performed without evidence of significant stenosis of epicardiale coronary arteries.Then, the working diagnosis changed in MINOCA and the patients underwent a cardiac magnetic resonance.The last showed a diffuse trans-mural/subepicardiale, biventricular late gadolinium enanchement (LGE) with a moderate reduction of systolic function of both the ventricles and a mild pericardial effusion.Thereafter, a supportive therapy in accordance with ESC position paper on acute myocarditis was started.In day 10, due to a worsening of heart failure symptoms and a deterioration of left ventricular ejecton fraction (40% -30%) with the persistence of elevation of TnI HS an endomyocardial biopsy was performed.This one showed diffuse fibrosis with an extensive lymphocytes infiltration compatible with acute myocarditis.In day 15, due to a lack of clinical improvement, the patient underwent a rheumatologic evaluation.The blood exams required, demonstrated an increase in anti-nucleus auto-antibody (ANA) and a therpy with corticosteroids plus azathioprine was started in the suspect of lupus myocarditis.The one month follow-up showed a normalization of TnI HS and PCR and an improvement of left ventricular ejection fraction (EF: 48%).In our opinion the case report presented is an example of good management of a myocarditis with atypical features solved thanks to the integration of the skills of cardiologist, radiologist and rheumatologist.The teamwork allowed to reach an uncommon etiological diagnosis and to start an effective therapy in order to improve patient prognosis.
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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 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.006 | 0.002 |
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".