SHM Converge Scientific Abstract ePoster Gallery-Elevated Troponin and Stroke: Solving a Puzzle

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A 35-year-old man presented with sudden left hand weakness after a recent upper respiratory illness. He had no fever, headache, dizziness, prior similar episodes, or recent influenza/COVID-19 vaccination. Exam showed mild left hand weakness (4/5). Routine labs and infectious testing, including influenza, COVID-19, HIV, and syphilis, were negative, except for an elevated troponin (0.26).<br /><br />He was admitted for stroke evaluation. Brain MRI revealed a focal cortical infarction in the right frontal/lateral lobe. Further cardiac evaluation showed a left ventricular apical thrombus on echocardiogram, and cardiac MRI confirmed the thrombus along with patchy myocardial enhancement throughout the left ventricle, consistent with myocarditis. Given the recent viral upper respiratory infection and negative workup for autoimmune, thrombotic, and other secondary causes, the myocarditis was thought to be viral.<br /><br />The stroke was attributed to cardioembolism from the LV thrombus, likely formed due to myocardial inflammation, regional wall motion abnormality, and blood stasis. He was started on apixaban for anticoagulation and atorvastatin for secondary stroke prevention. Apixaban was continued for 6 months.<br /><br />This case highlights viral myocarditis as an uncommon but important cause of elevated troponin, LV thrombus, and embolic stroke. Myocarditis is most often viral in developed countries and can range from mild symptoms to serious complications such as heart failure, arrhythmias, myocardial necrosis, thrombus formation, and stroke. Management is usually supportive; NSAIDs should generally be avoided, and immunosuppression is reserved for specific subtypes such as giant cell, eosinophilic, or autoimmune myocarditis. Current guidance supports anticoagulation for LV thrombus for 3 to 6 months.

Asset Subtitle

Prakash Adhikari

Meta Tag

Author List Prakash Adhikari, Shreyas Singireddy, Usha Mahat, Warsha Mandhan, Zahraa Rabeeah

Category Clinical Vignettes

Concept Myocarditis

Concept Left Ventricular Apical Thrombus

Concept Anticoagulation

Concept Troponin

Concept Cardioembolic Stroke

Distinguished Non-Finalist

Presenter Organization Tower Health-Reading Hospital

Presenting Author Prakash Adhikari

Track Adult

Keywords

viral myocarditis

left ventricular thrombus

embolic stroke

troponin elevation

cardioembolism

cardiac MRI

brain infarction

apixaban anticoagulation

upper respiratory infection

myocardial inflammation

Myocarditis

Left Ventricular Apical Thrombus

Anticoagulation

Troponin

Cardioembolic Stroke