The emergency department presented a 29-year-old man with two days of sudden onset progressive chest pain. The patient had H/o alcohol abuse and treatment-resistant schizoaffective disorder with multiple suicide attempts.
The patient first noted substernal chest pain worse with deep inspiration eight days after clozapine initiation. Symptoms worsened over the following two days. Electrocardiogram demonstrated ST elevations most prominent in V2-V3, as shown in the figure. Laboratory reports were remarkable for leukocytosis and elevated troponin, inflammatory markers and brain natriuretic peptide.
A cardiovascular exam was notable for tachycardia without murmurs or rubs. The patient had no peripheral oedema or elevated jugular venous pressure. In addition, CMR imaging showed global hypokinesis with a left ventricular (LV) ejection fraction (EF) of 45% and subtle late gadolinium enhancement of the epicardial lateral wall and lateral pericardium with abnormal parametric mapping as shown in the figure.
Like
Answers
Save
Share