Acute myocarditis presenting as accelerated junctional rhythm in Graves’disease:A case report  

作　　者：Meng-Mei Li Wei-Sheng Liu Rui-Cai Shan Jun Teng Yan Wang 

机构地区：[1]Department of Emergency Medicine,Qingdao Central Hospital,Affiliated Qingdao Central Hospital,Qingdao University,Qingdao 266042,Shandong Province,China [2]Department of Abdominal Ultrasonography,Qingdao Central Hospital,Affiliated Qingdao Central Hospital,Qingdao University,Qingdao 266042,Shandong Province,China

出　　处：《World Journal of Clinical Cases》2021年第35期11085-11094,共10页世界临床病例杂志

摘　　要：BACKGROUND Acute myocarditis is an acute myocardium injury that manifests as arrhythmia,dyspnea,and elevated cardiac enzymes.Acute myocarditis is usually caused by a viral infection but can sometimes be caused by autoimmunity.Graves’disease is an autoimmune disease that is a rare etiology of acute myocarditis.Accelerated junctional rhythm is also a rare manifestation of acute myocarditis in adults.CASE SUMMARY A rare case of new-onset Graves’disease combined with acute myocarditis and thyrotoxic periodic paralysis is reported.The patient was a 25-year-old young man who suddenly became paralyzed and felt palpitations and dyspnea.He was then sent to our emergency department(ED).Upon arrival,electrocardiography revealed an accelerated junctional rhythm and ST-segment depression in all leads,and laboratory findings showed extreme hypokalemia and elevated troponin I,with the troponin I level being 0.32 ng/mL(reference range,0-0.06 ng/mL).Coronary computer tomography angiography was performed,and there were no abnormal findings in the coronary arteries.Subsequently,the patient was admitted to the ED ward,where further testing revealed Graves’disease,along with continued elevated cardiac enzyme levels and B-type natriuretic peptide(BNP)levels.The troponin I level was 0.24 ng/mL after admission.All of the echocardiography results were normal:Left atrium 35 mm,left ventricle 48 mm,end-diastolic volume 102 mL,right atrium 39 mm×47 mm,right ventricle 25 mm,and ejection fraction 60%.Cardiac magnetic resonance was performed on the fifth day of admission,revealing myocardial edema in the lateral wall and intramyocardial and subepicardial late gadolinium enhancement in the lateral apex,anterior lateral,and inferior lateral segments of the ventricle.The patient refused to undergo an endomyocardial biopsy.After 6 d,the patient’s cardiac enzymes,BNP,potassium,and electrocardiography returned to normal.After the patient’s symptoms were relieved,he was discharged from the hospital.During a 6-mo follow-up,the patient was a

关 键 词：Graves’disease MYOCARDITIS Thyrotoxic periodic paralysis Accelerated junctional rhythm Case report 

分 类 号：R581.1[医药卫生—内分泌] R542.21[医药卫生—内科学]