CONGRESS ABSTRACT

Background Myopericarditis is an often insidious clinical entity characterized by difficult diagnosis. We describe the unique clinical case of a man with a minor stroke of cardioembolic etiology. Tests revealed the presence of an intraventricular thrombosis caused by eosinophilic infiltrative myopericarditis. Clinical Case A sixty-year-old man was admitted to the emergency room with transient right-sided weakness and dysarthria. His medical history included hypertensive heart disease and smoking. Blood tests revealed lymphocytosis and eosinophilic granulocytosis. Noncontrast brain CT revealed diffuse subcentimeter-sized hypodensities in the white matter, suspicious for cardioembolic etiology. The patient was admitted to the Internal Medicine Department for further diagnostic testing. ECG: sinus tachycardia with negative T waves in the precordial and inferior leads (no abnormalities present on the Emergency Department ECG). Echocardiogram: diffuse hypokinesia in all segments of the left ventricle, with akinesia of the apical segments and a suspicious thrombus formation at the apex of the left ventricle; preserved ejection fraction; mild non-tamponadacting pericardial effusion. Laboratory findings: elevated troponin and cardiac enzymes. The patient was transferred to the Cardiology Department, where a coronary CT scan ruled out significant coronary stenosis. Heart failure therapy and high-dose corticosteroids were administered with benefit. At follow-up two and six months after discharge, the patient was found to be in good hemodynamic control. Conclusions Myopericarditis is an inflammatory disorder of the myopericardium that presents with chest pain, dyspnea, and palpitations. The peculiarity of our case was its asymptomatic nature, suggesting a subacute neurological onset. The diagnosis was suspected based on ECG abnormalities and elevated troponin levels. Imaging techniques are essential in the diagnostic workup, as is coronary CT in the differential diagnosis of acute coronary syndrome. Endomyocardial biopsy is recommended in cases characterized by hemodynamic instability, so this procedure was not considered appropriate. Sharing this case aims to demonstrate that myopericarditis is a disease that can present insidiously, requiring an integrated approach using cardiovascular imaging techniques and a multidisciplinary approach.