Case Reports in Cardiology

Case Report

Fulminant Vasculitis Complicated by ST-Elevation Myocardial Infarction and Stroke

Table 1

Clinical, laboratory, and echocardiographic data.


	Day 1	Day 2	Day 4

Vitals
Temperature, °C	35.6	36.2	36.3
Heart rate, beats/min	150	143	98
Blood pressure, mmHg	120/105	123/87	113/73
Respiratory rate, breaths/min	25	30	22
SpO₂, %	100	98	99
Body mass index, kg/m²	32	32	32

Laboratories
Troponin I, ng/L	7.0	—	—
Hs-troponin, ng/L	—	206,452	174,327
NT-proBNP, ng/mL	—	1,059	—
White blood cells, 10⁹/L	53	25	16
Hemoglobin, g/dL	16	13	10
Platelets, 10⁹/L	460	364	254
Creatinine, mg/dL	0.60	0.80	0.50
Aspartate transaminase, IU/L	1,478	533	113
Alanine aminotransferase, IU/L	158	120	53
International normalized ratio	5.1	2.0	1.1
Lactate, mmol/L	6.2	3.6	1.8
Erythrocyte sedimentation rate, mm/hr	N/A	58	—
C-reactive protein, mg/dL	2.9	125	—
Hemoglobin A1C, %	5.5	5.4	—
Total cholesterol, mg/dL	193	137	—
Triglycerides, mg/dL	224	146	—
HDL cholesterol, mg/dL	44	33	—
LDL cholesterol, mg/dL	104	79	—

Echocardiogram
LVEDV, mL	115		174
LVESV, mL	89		110
LVEF, %	23		37
Left atrial volume, mL/m²	15.5		15.3
RVSP, mmHg	—		44.6
Valvular heart disease	None		None

Cardiac hemodynamics
RA pressure, mmHg	3	5	5
PA mean pressure, mmHg	26	25	27
PCW pressure, mmHg	—	15	—
Cardiac output, L/min	4.1	3.8	5.7
Cardiac index, L/min/m²	1.9	1.7	2.6

Infectious studies
HIV			Negative
Hepatitis B DNA PCR			Negative
Hepatitis C			Negative
Blood cultures			Negative

Rheumatologic studies
ANA titer			1 : 320, speckled
Anti-ds-DNAb			Negative
Anti-Smith			Negative
Anti-RNP			Negative
Anti-SSA			Negative
Anti-SSB			Negative
ANCA IgG			Negative
Antimyeloperoxidase			Negative
Antiproteinase 3			Negative
C3			Normal
C4			Normal
Lupus anticoagulant			Negative
Beta-2 glycoprotein-1 IgG/IgM			Negative

Abbreviations: ANA: antinuclear antibody; ANCA: antineutrophil cytoplasmic antibodies; ds-DNA: double stranded DNA; HDL: high-density lipoprotein; HIV: human immunodeficiency virus; Hs: high sensitivity; LDL: low-density lipoprotein; LVEDD: left ventricular end diastolic diameter; LVEDS: left ventricular end systolic dimension; LVEF: left ventricular ejection fraction; MR: mitral regurgitation; RNP: ribonucleoprotein; RVSP: right ventricular systolic pressure; SSA/SSB: Sjogren’s syndrome-related antigen A/B.