PMID- 30962193
OWN - NLM
STAT- MEDLINE
DCOM- 20200605
LR  - 20200605
IS  - 1468-201X (Electronic)
IS  - 1355-6037 (Print)
IS  - 1355-6037 (Linking)
VI  - 105
IP  - 15
DP  - 2019 Aug
TI  - Connection between the heart and the gut.
PG  - 1148-1196
LID - 10.1136/heartjnl-2019-314832 [doi]
AB  - CLINICAL INTRODUCTION: A 45-year-old man with ulcerative colitis was admitted 
      with bloody diarrhoea and chest pain. Inflammatory markers and high-sensitivity 
      troponin were elevated (C reactive protein 57 mg/L, white cell count 
      10.65x10(9)/L, neutrophil 6.6x10(9)/L, Troponin-I 663 mmol/L). The ECG showed 
      inferior ST-elevation. Urgent coronary angiography revealed unobstructed coronary 
      arteries. Inpatient cardiovascular magnetic resonance (CMR) was arranged to 
      determine the aetiology of the myocardial infarction with non-obstructive 
      coronary arteries. The imaging protocol at 1.5 T included balanced steady-state 
      free precession cine images, T2-weighted oedema sequences, and early and late 
      gadolinium enhancement (LGE). Native T1 and T2 mapping images provided advanced 
      tissue characterisation (figure 1). QUESTION: What is the most likely diagnosis 
      based on the MRI findings? Multiple embolic myocardial infarctions in the right 
      coronary artery territory.Acute autoimmune myocarditis.Cardiac sarcoidosis.Stress 
      (Takotsubo) cardiomyopathy.Multiple embolic myocardial infarctions in the left 
      circumflex coronary artery territory. heartjnl;105/15/1148/F1F1F1Figure 1(A) 
      Balanced steady-state free precession (bSSFP) left ventricular long-axis, 
      three-chamber view. (B) T2 short-tau inversion recovery. (C) Early gadolinium 
      enhancement demonstrating high signal intensity indicative of hyperaemia with 
      capillary leakage (arrowed). (D) Late gadolinium enhancement with high signal 
      intensity indicative of increased extracellular space (arrowed). (E) bSSFP left 
      ventricular short-axis view. (F) Native myocardial T1 mapping with elevated 
      native T1 mapping values in the inferior wall (arrowed). (G) Native myocardial T2 
      mapping with elevated native T2 values in the inferior wall, indicative of oedema 
      (arrowed). (H) Late gadolinium enhancement with high signal intensity indicative 
      of increased extracellular space (arrowed).
CI  - (c) Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No 
      commercial re-use. See rights and permissions. Published by BMJ.
FAU - Berlot, Bostjan
AU  - Berlot B
AUID- ORCID: 0000-0002-5805-5368
AD  - Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, 
      Bristol, UK.
AD  - Clinical Research and Imaging Centre, University of Bristol, Bristol, UK.
FAU - Harries, Iwan
AU  - Harries I
AD  - Clinical Research and Imaging Centre, University of Bristol, Bristol, UK.
AD  - NIHR Biomedical Research Centre, University Hospitals Bristol NHS Foundation 
      Trust, Bristol, UK.
FAU - Bucciarelli-Ducci, Chiara
AU  - Bucciarelli-Ducci C
AD  - Clinical Research and Imaging Centre, University of Bristol, Bristol, UK.
AD  - NIHR Biomedical Research Centre, University Hospitals Bristol NHS Foundation 
      Trust, Bristol, UK.
LA  - eng
PT  - Case Reports
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20190408
PL  - England
TA  - Heart
JT  - Heart (British Cardiac Society)
JID - 9602087
SB  - IM
MH  - Colitis, Ulcerative/*complications
MH  - Humans
MH  - Magnetic Resonance Imaging
MH  - Male
MH  - Middle Aged
MH  - Myocarditis/*diagnostic imaging/*etiology
PMC - PMC6662949
OTO - NOTNLM
OT  - acute coronary syndromes
OT  - cardiac magnetic resonance (cmr) imaging
OT  - myocarditis
COIS- Competing interests: None declared.
EDAT- 2019/04/10 06:00
MHDA- 2020/06/06 06:00
PMCR- 2019/07/29
CRDT- 2019/04/10 06:00
PHST- 2019/01/29 00:00 [received]
PHST- 2019/02/26 00:00 [revised]
PHST- 2019/03/11 00:00 [accepted]
PHST- 2019/04/10 06:00 [pubmed]
PHST- 2020/06/06 06:00 [medline]
PHST- 2019/04/10 06:00 [entrez]
PHST- 2019/07/29 00:00 [pmc-release]
AID - heartjnl-2019-314832 [pii]
AID - 10.1136/heartjnl-2019-314832 [doi]
PST - ppublish
SO  - Heart. 2019 Aug;105(15):1148-1196. doi: 10.1136/heartjnl-2019-314832. Epub 2019 
      Apr 8.