"Unstable angina" in a man aged 53 years


Clinical introduction

A man aged 53 years presented to the emergency department with several hours of substernal chest pain radiating to his left arm. He had multiple myeloma treated with bortezomib, lenalidomide and dexamethasone. ECG showed inferior ST segment elevations. Troponin I was >73 ng/mL on hypersensitive troponin assay. Cardiac catheterisation was performed without obstructive coronary disease. Transthoracic echocardiogram showed normal left ventricular ejection fraction with abnormal global longitudinal strain of –10%. The patient developed ventricular tachycardia requiring electrical cardioversion. Repeat echocardiogram 48 hours later showed a decline in the left ventricular ejection fraction to 45%. Cardiac MRI was done for further evaluation (figure 1A, B).


Which of the following is the most likely diagnosis?

  • Active cardiac sarcoid

  • Myocarditis

  • Spontaneous coronary artery dissection

  • Coronary artery thrombosis

  • Stress cardiomyopathy

  • Figure 1

    (A) T2-weighted black-blood short axis image through the mid-left…


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