Clinical Cases: Differentiating acute from chronic cardiac conditions

Case   64-year old man

Key signs and symptoms Slowly increasing dyspnoea for the past 3 weeks, most recently exertional dyspnoea with minimal effort, weight gain of 3 kg in 1 week

Medical history Dilated cardiomyopathy diagnosed 3 years ago

Clinical examination Third heart sound, rales over both lung bases, jugular vein congested (12 cm H2O), slight ankle edema

Laboratory test results Result   Reference range CRP 4 mg/L   <5 mg/dL Serum creatinine 1.2 mg/dL   <9 mg/dL GFR 90 mL/min/1.73 m2   >90 mL/min/1.73 m2 NT-proBNP 1375 ng/L   < 300 ng/L to rule-out AHF and >900 ng/L HF likely if 50-75 year-old (confirmation with imaging)

ECG Atrial fibrillation, non-specific repolarisation abnormalities in leads I, II, aVL, V2 – V6.

Troponin kinetic profile

Magnetic resonance imaging (MRI)

 

Diagnosis

Acute decompensated heart failure with dilated cardiomyopathy

Clinically acute decompensation of chronic heart failure secondary to dilative cardio-myopathy with elevated NT-proBNP in acute heart failure. The magnetic resonance imaging (MRI) scan shows dilatation of all cardiac chambers and severely restricted systolic LV function (EF = 24 %). The cTnT-hs kinetic profile shows a non significant fluctuation of less than 50 % increase in the cTnT-hs levels. This variation is < 7 ng/L (2 hours later) and < 9.2ng/L (3 hours later) (< 20 %). A similar profile for cTnT-hs levels could appear in case of myocarditis.

 

Conclusion

There is no rise or fall in cTnT-hs values needed for AMI diagnosis.