Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website https://www.cardiologyres.org

Case Report

Volume 2, Number 3, June 2011, pages 123-126

Markedly Elevated Cardiac Bio-Markers at Presentation With Normal Ventricular Function: A Novel Clinical Subset of Myocarditis Manifestation

Figures

Figure 1. Trend of troponin-I over days of myocarditis hospitalization.

Figure 2. Sagital view of the heart on Cardiac MRI with T2 weighted and viability/scar imaging showing diffuse circumferential, abnormal myocardial enhancement consistent with myocarditis of the left ventricle (shown by arrows).

Tables

**Table 1.** Various Clinical Parameters of the Case
Initial Vitals	Blood pressure: 135/80 mmHg; Heart rate: 77/min; Respiratory rate: 18/min; Temperature: 35.6 °C; O₂ sat: 100% on room air
Initial Labs	WBC: 12.8 (74% polymorphs; 18% lymphocytes) TSH, Mg²⁺, RF, CRP, D-Dimer, ESR and Hgb were all unremarkable.
Initial Cardiac Markers	Troponin I: 109.13 ng/ml (0.00 - 0.04); Creatine Kinase: 1296 IU/L (45 - 230); CK-MB mass: 121.9 ng/ml (≤ 5); MB index: 9.4 (0.0 - 3.9)
EKG	Normal sinus rhythm with S1Q3, right axis deviation and RSr’ pattern in V1
Imaging/Nuclear studies	CT Angiogram Chest: No evidence of acute Pulmonary Embolism Ventilation/Perfusion scan: Negative for Pulmonary Embolism
Ejection Fractions during entire hospitalization and follow ups	Day 1 (at presentation): 60 - 65%; no wall motion abnormality Day 2 (day of resuscitation): 20 - 25%; no wall motion abnormality Day 3: 45%; no wall motion abnormality Day 10 (at discharge): 45%; no wall motion abnormality 2-month follow up: 50%; no other abnormalities 6-month follow up: 55%; no other abnormalities

**Table 2.** Left Ventricular Internal Diameters at Various Points During the Hospital Course
	On admission	On the day of resuscitation (day 3)	At discharge
LVIDd: Left Ventricular Internal Diameter at the end of diastole; LVIDs: Left Ventricular Internal Diameter at the end of systole.
LVIDd	4.4 cm	4.3 cm	4.3 cm
LVIDs	3.0 cm	3.9 cm	2.8 cm
LV Ejection fraction	55 - 60%	20 - 25%	45%