MyMedR

Eosinophilic myocarditis mimicking acute coronary syndrome in a young man with T-lymphoblastic lymphoma and hypereosinophilia

Raffali MAA, Boon Cong B, Muhammad SF, Che Hassan HH

BMJ Case Rep, 2023 Sep 25;16(9).

PMID: 37748814 DOI: 10.1136/bcr-2023-255396

A man in his 20s with underlying chemorefractory primary T-lymphoblastic lymphoma and hypereosinophilia developed acute chest pain in the ward after readmission for disease progression. ECG showed widespread ST depression and serum troponin was markedly elevated. Transthoracic echocardiography showed diffused thrombus deposition with preserved ejection fraction consistent with eosinophilic myocarditis. The patient ultimately succumbed to the disease, after complications with severe hospital-acquired pneumonia.

Fulltext History of Severe Hypoglycemia in Type 2 Diabetes Mellitus Unmasked Significant Atherosclerotic Coronary Artery Disease: A Comparative Case Control Study

Raffali MA, Muhammad SF, Hamid HA, Nawi AM, Kamaruddin NA

J ASEAN Fed Endocr Soc, 2021;36(1):37-44.

PMID: 34177086 DOI: 10.15605/jafes.036.01.15

Objectives: A history of severe hypoglycemia (SH) is associated with cardiovascular (CV) events among patients with type 2 diabetes mellitus (T2DM). In this study, we compared the severity of atherosclerotic coronary artery disease (ACAD) in T2DM patients with and without a history of SH.

Methodology: We conducted a comparative case-control study involving 28 T2DM patients with a history of SH within the last 5 years with no documented ACAD, and matched them with 28 T2DM patients with no history of SH. All subjects underwent coronary artery calcium scoring (CACS) with or without coronary computed tomographic angiography (CCTA) to evaluate the severity of ACAD.

Results: A history of SH in T2DM was associated with a higher prevalence of significant ACAD (79% versus 46%, p=0.026). A high CACS (≥100) was seen in a greater number of patients with a history of SH compared to those without (75% versus 43%, p=0.029). Similarly, there was a higher prevalence of obstructive CAD in those with a history of SH compared to those without (72% versus 39%, p=0.036). Median C-reactive protein level was also higher among patients with a history of SH (0.41 mg/dL versus 0.16 mg/dL, p=0.029).

Conclusion: In patients with T2DM, a history of SH is significantly associated with ACAD compared to those without SH. A history of SH warrants screening for ACAD.

Delayed acute myocardial infarction in a young man with traumatic multivessel coronary artery dissection after blunt chest injury

Raffali MAA, Azmi MI, Muhammad SF, Che Hassan HH

BMJ Case Rep, 2024 Apr 29;17(4).

PMID: 38684352 DOI: 10.1136/bcr-2024-260649

A man in his 20s with no medical illness sustained a blunt chest injury with pneumothorax and lung contusion after involving in a motorbike accident. Five days postadmission, he subsequently had myocardial infarction with cardiac arrest, in which coronary angiogram and intravascular ultrasound showed diffused multivessel coronary artery dissection.

Fulltext Disseminated Tuberculosis With Myocarditis and Intracardiac Thrombus in a Previously Young Healthy Woman

Raffali MA, Muhammad SF, Tiau Wei Jyung P, Farouk D, Zohdi A, Che Hassan HH

JACC Case Rep, 2021 Nov 03;3(15):1661-1666.

PMID: 34766014 DOI: 10.1016/j.jaccas.2021.08.020

A 33-year-old woman with newly diagnosed disseminated tuberculosis presented with acute heart failure and incidental findings of intracardiac thrombus, demonstrating possible tuberculous myocarditis. (Level of Difficulty: Intermediate.).

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