A 52-year-old woman with hypertension presents to the emergency department with a 6-week history of progressive dyspnea, orthopnea, and fatigue. She denies chest pain, has no smoking history, and takes only lisinopril. Vital signs: BP 138/86 mmHg, HR 108 bpm, RR 22/min, SpO2 93% on room air. Physical examination reveals elevated jugular venous pressure, bilateral crackles, and a displaced point of maximal impulse. Laboratory studies show troponin I 0.08 ng/mL (normal <0.04) and BNP 850 pg/mL. Echocardiography demonstrates global left ventricular hypokinesis with ejection fraction of 26%. Coronary angiography shows normal epicardial coronaries with normal TIMI flow. Cardiac MRI reveals patchy subendocardial fibrosis in a non-ischemic distribution. Which of the following is the most likely diagnosis?
- A)Acute coronary syndrome with unobstructed coronary arteries (MINOCA)
- B)Acute myocarditisGABARITO
- C)Dilated cardiomyopathy from infiltrative disease
- D)Takotsubo cardiomyopathy with apical ballooning
- E)Spontaneous coronary artery dissection with recanalization
Explicação
Acute myocarditis is the most likely diagnosis. The clinical presentation of subacute dyspnea and fatigue with relatively preserved hemodynamic stability, elevated troponin, normal coronaries on angiography, and cardiac MRI showing subendocardial (often subepi... Ver explicação completa e trilha adaptativa →