Dr. Muhammad Zohaib Siddiq
Cardiology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
Would a giant cell myocarditis show on a late enhancement MRI of the heart? I have worrying health issues, and I am increasingly bedridden. I have increasing muscle pain, chest palpitations, slowly increasing heart size, and fluctuation in heart rate with tachycardia and then bradycardia. I take Nebivolol to control the severe tachycardia. They have gotten me a proBNP test and troponin test, which came back normal. Also, my heart MRI was normal, and there was no late enhancement. I have worrying body symptoms as well as elevated calcium (2.7 mmol/L), which can be indicative of giant cell myositis or myocarditis. I have elevated calcium for two years, and nobody knows why. PTH and PTHrP came back negative. Now, I have increasing heart symptoms and muscular pains. I have a history of severely elevated CRP two years ago with CRP 115 mg/L and lactate 2.8 mmol/L. This was the start of my symptoms, but now it has progressed so badly that I cannot get up. CRP is normal now. I have tried Ceftriaxone and Doxycycline for a positive Lyme disease test, and they did not work. I have tried Opipramol for mental calming. It calmed my mind, and all symptoms stayed, though.
Hello,
Welcome to icliniq.com.
I understand your concern.
Myocarditis can show up on MRI (magnetic resonance imaging), but in myocarditis, troponin is markedly raised, and also pro-BNP (pro–B-type natriuretic peptide) levels. In myocarditis, the heart muscle weakens and causes fluid accumulation in the lungs. Giant cell myocarditis is a very dangerous and life-threatening condition, but your tests are normal, and you are fine. So, it cannot be giant cell myocarditis. You should have a comprehensive examination and workup to make a diagnosis. Please share your ECG (electrocardiogram), ECHO (echocardiography), MRI, chest X-ray, and other workup so that I can guide you better.
Hope this helps.
Regards.
Patient's Query
Hi doctor,
Thank you.
I have attached my reports for you to check. The isolated systolic elevation on stress ECG got me really worried. However, they never found anything. What would you suggest?
Hello,
Welcome back to icliniq.com.
I understand your concern.
I have gone through your reports (attachments are hidden to protect the patient's identity). ST elevations should be assessed on what type of elevations are there, concave elevations, convex elevations, upsloping, horizontal or downsloping, and to see whether any reciprocal changes in opposite leads are there. Please send me your ECG. Since MRI is normal, most likely, ECG will not have serious changes.
Hope this addresses your concern.
Kind regards.
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Cardiology
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