case_images: PMC11097718_01
case_images: Electrocardiogram at admission. ECG at the initial admission showed (I) an elevated ST segment in AVL lead and (II and III) changes in AVF and V2-V6 ST-T waves, indicating a high lateral myocardial infarction.
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case_images: T wave changes (Figure 1).
case_images: Changes in transthoracic echocardiography. (A) Echocardiography at admission showed left ventricular thickening. (B) Echocardiography 1 month after discharge showed local pericardial thickening and adhesion in the inferior and lateral walls of the left ventricle during outpatient follow-up. (C) Echocardiography at the second admission showed extensive involvement in the aorta, peripulmonary arteries, left ventricle, and left atrium. (D) Echocardiography 4 months after the initial admission showed extensive involvement in the aorta, peripulmonary arteries, left ventricle, and left atrium.
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case_images: T (254.9 pg/mL), creatine kinase (CK; 440 U/L), creatine kinase isoenzyme MB (CK-MB; 30.3 U/L), myoglobin (103.1 ng/mL) and measured using Philips IU22 color ultrasonic diagnostic instrument demonstrated 70% left ventricular ejection fraction, left heart enlargement, left ventricular wall thickening, left regional ventricular wall motion abnormality, moderate mitral regurgitation, a small amount of pericardial effusion, and normal left ventricular systolic function (Figure 2A). The medical team diagnosed acute high lateral myocardial infarction and selective coronary angiography after coronary showed no clear stenosis of the left and right coronary arteries, with thrombolysis in myocardial infarction (TIMI) grade 3 flow. The possibility of coronary artery spasm was considered because no abnormal findings were found during coronary angiography. The ECG results indicated sinus rhythm, ST-T changes, local pericardial thickening, and adhesion in the inferior and lateral walls of the left ventricle (Figure 2B). The patient's left ventricular systolic and diastolic function decreased (Figure 2C), and the levels of the tumor markers CA125 and neuron-specific enolase were abnormal. However, echocardiography still showed extensive involvement in the aorta, peripulmonary arteries, left ventricle, and left atrium (Figure 2D), suggesting a poor prognosis.   One month after this follow-up, the patient succumbed to death owing to a sudden episode of ventricular tachycardia, ventricular fibrillation, and decreased blood pressure despite resuscitation efforts (Figure 3).
case_images: Timeline showing the clinical course in this patient.
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case_images: However, echocardiography still showed extensive involvement in the aorta, peripulmonary arteries, left ventricle, and left atrium (Figure 2D), suggesting a poor prognosis.   One month after this follow-up, the patient succumbed to death owing to a sudden episode of ventricular tachycardia, ventricular fibrillation, and decreased blood pressure despite resuscitation efforts (Figure 3).