Clinical Cases: Differentiating acute from chronic cardiac conditions

19 November 2021

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

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)

Click to reveal the answer

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.