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59/F/dyspnea, loss of consciousness /ER, Additional Plan, Treatment, st…

- - - - chest pain, syncope, dyspnea&
        
        Pfizer's second dose of COVID vaccine a month ago
        
        WHO 화이자 mRNA백신과 경증 심근염 연관
        
        DIAGNOSIS
        
        TNL high sensitivity abnormal 316.4 pg/mL
        
        normal CK-MB: 3.3ng/mL
        indicating acute myocarditis
        
        WBC abnormal 11,890 / mm^3
        
        cardiac MRI
        
        Intramyocardial late gadolinium enhancement (LGE)
      - Apical Ballooning Syndrome
        
        cause
        
        transient changes in cardiac function leading to myocardial tissue injury
        
        DIAGNOSIS
        
        Blood Chemistry
        
        Increased TnI(316.4pg/mL)
        
        Increased NT-proBNP
        
        TTE
        : LVEF 25%
        'mid to apical segment akinesia'
        -> R/O
        
        Myocardial Infarction
        
        Cause
        
        Thrombosis
        
        DIAGNOSIS
        
        Screening
        
        1 more item...
        
        Confirm test
        
        1 more item...
        
        CAD
        
        DIAGNOSIS
        
        MRA - About 1.0cm length of mild degree atheromatous stenosis in right carotid bulb area
        
        1 more item...
        
        Classification
        
        mild: 15-49% 막힘
        
        moderate: 50-79% 막힘
        
        severe: 80-99% 막힘.
      - Pulse 110/min
        
        Tachycardia
        
        QRS파는 2칸 ~ 3칸 범위 내에
        
        narrow QRS
        
        Atrial Tachycardia
        
        DIAGNOSIS
        
        1 more item...
        
        출처
        
        PSVT
        
        Atrioventricular Node Re-Entrant Tachycardia (AVNRT)
        
        1 more item...
        
        Atrioventricular Reciprocating Tachycardia (AVRT)
        
        1 more item...
        
        출처
        
        DIAGNOSIS
        
        1 more item...
- - - - Brain CT (-)
        {추후, lumbar puncture} ,
        angiography (-) -golden standard
        -2주 후 재검DSA(digital subtraction angiography)
        Brain MRI (-)
        
        R/O
- - - - Thrombogenesis
      - Sympathoadrenal activation Vasoconstriction
        
        Cardiac arrhythmias Ischemia
        
        Glucose 409 mg/dL (75-106) - R/O
      - Endothelial dysfunction
      - Cardiac autonomic neuropathy
  - - - R/O-not enlarged thyroid