0:00

Case number six I'm going to put a still image

0:03

up here.

0:05

The six was a young man. In fact, this

0:08

was a physician working at one of the medical centers where I

0:11

previously worked. So 30 year

0:14

old young man with acute chest pain

0:17

who presented to the Ed.

0:19

And a cardiacama was performed as shown on this slide

0:22

are.

0:24

Sean access in Long access images from a late galive enhanced

0:27

sequence the correct diagnosis question

0:30

number one up, please is

0:33

it in my Carlin function? Is it

0:36

hypertrophic cardiomyopathy?

0:38

Has the patient had myocardia in

0:41

episode of acute mindcarnitis, is it stress related to cardiomyopathy or

0:44

do we think that the patient has an idiopathic dilated

0:47

cardiomyopathy acute? My heart is excellent.

0:50

This is the patient case of acute. Myocarditis notice

0:53

the sub-epicardial related enhancement in

0:56

the infrarilateral wall these bright spots

0:59

in the lateral wall are in the sub epicondial region

1:02

as opposed to some endocardial region. Some intercontinent

1:05

region typically is affected by ischemic hard disease, whereas

1:08

in regions outside of

1:11

the sub-inducardium, if there's enhancement one has to consider non-ish Community

1:14

Technologies, the young in the young patient with chest

1:17

pain and some people enhancement in

1:20

the National wall, the primary difference diagnosis or

1:23

most likely conditions acute myocarditis.

1:26

installation of acute my conductors

1:28

Sub-epical enhancement in the lateral wall.

1:31

Okay. Next question pertaining to this case is asked

1:34

were the most common geology in

1:37

patients with chest pain and negative ECG. Sorry negative

1:40

troponians and normal coronary arteries. The ECG

1:43

can be abnormal in acute microads can mimic and infant so the

1:46

Communist condition etiology of

1:49

Chest pain with normal coronary arteries and elevated hormones which

1:52

one of the following my current infarction. Yes, Mike

1:55

very rarely in acute Michael infraction. The

1:58

coronary artist can be normal because of an embolic event or the

2:01

abstract relations result Mike. Yes,

2:04

good. My credits the Communist cause of chest

2:07

pain with normal coronary arteries is acute myocardits and

2:10

clinical practice.

2:11

All the other conditions can cause chest pain

2:15

or with normal coronary artery is the commonest presentation will be

2:18

in acute myocarditis. So patients presents to the

2:21

Ed with chest pain mimicking acute MI and

2:24

the crown the first diagnostic pathway

2:28

is to do a catheter and

2:31

geography because they acute Michael infections treatable if

2:34

there's obstructive currently actually see so if the coronary art

2:37

is a normal the most likely diagnosed in a patient with chest pain

2:40

is acute mind connectors.

2:43

Sub apical enhancement in the lateral wall

2:46

is a key finding of figured micronitis. The last

2:49

question pertaining to this case is

2:52

linear midwell enhancement is a septum is a

2:55

feature which of the following conditions. So we've seen sub endocardial enhancement

2:58

in ischemic heart disease. We've seen some epicondyle enhancement

3:01

in acute mycardatus patchy enhancement

3:04

in deception in hypertrophic cardiomyopathy

3:07

and all the cases we've seen

3:09

amyloidosis we've not seen as yet of

3:12

it question here is which of the following conditions leads to

3:15

Mid 1 enhancement in the septum

3:18

Yes, the correct answer is a idiopathic dilated

3:21

cardiomyopathy. The majority of the

3:24

patients of egyptic dilate cardiometer will not have enhancement. However, if

3:27

there is enhancement approximately approaching 40 to 50

3:30

percent will have may have midwall enhancement to

3:33

the interventricular section.

3:35

Um, all the other choices are not correct

3:38

hypertrophic cardio Market the rates

3:41

enhancement in the septum patchy midwall enhancement ischemic cardiomabulates,

3:44

a sub endocardial enhancement cardigamallodose

3:47

to see the leads to diffuse enhancement or

3:50

Global sub endocardial announcement eosinophilic. Myocarditis

3:53

can also lead to sub in the current enhancement typically in the apical regions.

3:56

So idiopathic dilated condomatic the mid

3:59

one enhancement is a key finding if present and

4:02

it also allows risk stratification idiopathically to

4:06

come out. This scar is a risk factor for certain cardiac day.

4:09

Over in the bag rejection fractions. Okay, so

4:12

that was case number six, I

4:15

believe and

4:18

think now we are on to the next case is case

4:21

number seven.