A 56-year-old woman with breathlessness

Alastair Moss; Marc R Dweck; Peter D O'Kane

doi:10.1136/heartjnl-2016-310611

A 56-year-old woman with breathlessness

Alastair Moss, Marc R Dweck, Peter D O'Kane

Research output: Contribution to journal › Comment/debate › peer-review

Abstract

CLINICAL INTRODUCTION: A 56-year-old female with adult-onset asthma was admitted to the cardiology service with intermittent left-sided chest pain and progressive dyspnoea. Twelve months prior to this admission, she had received a course of prednisolone for bilateral anterior uveitis. Physical examination was unremarkable with blood sampling revealing a marked eosinophilia (eosinophil count 17.3×10(9)/L) and a perinuclear antineutrophil cytoplasmic antibody staining pattern on indirect immunofluorescence microscopy (myeloperoxidase antibodies 83 IU/mL). ECG demonstrated anterolateral T-wave inversion (see online supplementary figure S1). High-sensitivity troponin T was elevated at 100 ng/L. Invasive coronary angiography showed unobstructed coronary arteries. Echocardiography and cardiac magnetic resonance (CMR) were performed (figure 1).

QUESTION: What is the most appropriate therapy? Beta-blockade and ACE inhibitionMethylprednisoloneIntravenous antibioticsEndocardiectomyImplantable cardioverter defibrillator (ICD).

Original language	English
Journal	Heart
DOIs	https://doi.org/10.1136/heartjnl-2016-310611
Publication status	Published - 29 Nov 2016

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10.1136/heartjnl-2016-310611

Moss A 56 year old woman
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Cite this

@article{cef0d4f8f16348da95a95586e45bd258,

title = "A 56-year-old woman with breathlessness",

abstract = "CLINICAL INTRODUCTION: A 56-year-old female with adult-onset asthma was admitted to the cardiology service with intermittent left-sided chest pain and progressive dyspnoea. Twelve months prior to this admission, she had received a course of prednisolone for bilateral anterior uveitis. Physical examination was unremarkable with blood sampling revealing a marked eosinophilia (eosinophil count 17.3×10(9)/L) and a perinuclear antineutrophil cytoplasmic antibody staining pattern on indirect immunofluorescence microscopy (myeloperoxidase antibodies 83 IU/mL). ECG demonstrated anterolateral T-wave inversion (see online supplementary figure S1). High-sensitivity troponin T was elevated at 100 ng/L. Invasive coronary angiography showed unobstructed coronary arteries. Echocardiography and cardiac magnetic resonance (CMR) were performed (figure 1).QUESTION: What is the most appropriate therapy? Beta-blockade and ACE inhibitionMethylprednisoloneIntravenous antibioticsEndocardiectomyImplantable cardioverter defibrillator (ICD).",

author = "Alastair Moss and Dweck, {Marc R} and O'Kane, {Peter D}",

note = "Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.",

year = "2016",

month = nov,

day = "29",

doi = "10.1136/heartjnl-2016-310611",

language = "English",

journal = "Heart",

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TY - JOUR

T1 - A 56-year-old woman with breathlessness

AU - Moss, Alastair

AU - Dweck, Marc R

AU - O'Kane, Peter D

N1 - Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

PY - 2016/11/29

Y1 - 2016/11/29

N2 - CLINICAL INTRODUCTION: A 56-year-old female with adult-onset asthma was admitted to the cardiology service with intermittent left-sided chest pain and progressive dyspnoea. Twelve months prior to this admission, she had received a course of prednisolone for bilateral anterior uveitis. Physical examination was unremarkable with blood sampling revealing a marked eosinophilia (eosinophil count 17.3×10(9)/L) and a perinuclear antineutrophil cytoplasmic antibody staining pattern on indirect immunofluorescence microscopy (myeloperoxidase antibodies 83 IU/mL). ECG demonstrated anterolateral T-wave inversion (see online supplementary figure S1). High-sensitivity troponin T was elevated at 100 ng/L. Invasive coronary angiography showed unobstructed coronary arteries. Echocardiography and cardiac magnetic resonance (CMR) were performed (figure 1).QUESTION: What is the most appropriate therapy? Beta-blockade and ACE inhibitionMethylprednisoloneIntravenous antibioticsEndocardiectomyImplantable cardioverter defibrillator (ICD).

AB - CLINICAL INTRODUCTION: A 56-year-old female with adult-onset asthma was admitted to the cardiology service with intermittent left-sided chest pain and progressive dyspnoea. Twelve months prior to this admission, she had received a course of prednisolone for bilateral anterior uveitis. Physical examination was unremarkable with blood sampling revealing a marked eosinophilia (eosinophil count 17.3×10(9)/L) and a perinuclear antineutrophil cytoplasmic antibody staining pattern on indirect immunofluorescence microscopy (myeloperoxidase antibodies 83 IU/mL). ECG demonstrated anterolateral T-wave inversion (see online supplementary figure S1). High-sensitivity troponin T was elevated at 100 ng/L. Invasive coronary angiography showed unobstructed coronary arteries. Echocardiography and cardiac magnetic resonance (CMR) were performed (figure 1).QUESTION: What is the most appropriate therapy? Beta-blockade and ACE inhibitionMethylprednisoloneIntravenous antibioticsEndocardiectomyImplantable cardioverter defibrillator (ICD).

U2 - 10.1136/heartjnl-2016-310611

DO - 10.1136/heartjnl-2016-310611

M3 - Comment/debate

C2 - 27899427

SN - 1355-6037

JO - Heart

JF - Heart

ER -

A 56-year-old woman with breathlessness

Abstract

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