A 57-year-old woman with a history of hypertension presented to a local hospital describing 1 day of intermittent central chest pain that radiated to the jaw. Five days prior to admission, she attended the Minnesota State Fair, where she ate a variety of items, including chicken quesadillas. The following day she developed abdominal pain with vomiting and diarrhea. On examination, she was afebrile (36.6ºC) and mildly hypertensive to 149/84 mm Hg. Cardiorespiratory and abdominal examinations were unremarkable. Laboratory data revealed a normal complete blood count and normal basic metabolic panel. Troponin-I was elevated at 4.427 ng/mL. Initial electrocardiogram (ECG) showed normal sinus rhythm without significant ST changes. She was started on a heparin infusion and transferred to a tertiary hospital for management of non-ST-segment elevation myocardial infarction.
Upon arrival, she experienced recurrent chest pain. Repeat ECG demonstrated dynamic changes with new mild ST elevation in the inferior and lateral leads with diffuse PR depression. Repeat troponin was 5.954 ng/mL and C-reactive protein was elevated at 2.50 mg/dL (normal: <0.50 mg/dL). Transthoracic echocardiogram showed mild hypokinesis of the septum and mid-anterior wall. Cardiac magnetic resonance imaging (CMR) was performed and demonstrated patchy subepicardial late enhancement at the basal and distal inferior wall and mid-inferolateral wall, edema in the mid-inferolateral wall, and hypokinesis of mid- and distal-inferior wall consistent with myopericarditis. (Figure)
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-Kristen Westenfield, MD, Christine Wagner, MD, Victor Cheng, MD, Kevin M. Harris, MD
