Acute heart failure and rhabdomyolysis: a clue for the diagnosis of polymyositis with cardiac involvement
Polymyositis is an idiopathic inflammatory myopathy, characterized by proximal muscle weakness and sometimes extramuscular manifestations. We report the case of a 51-year-old male, with history of complete heart block, which required pacemaker implantation, and subsequently heart failure, presenting...
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| Format: | Article |
| Language: | English |
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PAGEPress Publications
2017-08-01
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| Series: | Reumatismo |
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| Online Access: | http://www.reumatismo.org/index.php/reuma/article/view/924 |
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| author | P. Pinto-Lopes L. Carneiro-Leão R. Morais J. Pinheiro A. Vieira Lopes P. Bettencourt |
| author_facet | P. Pinto-Lopes L. Carneiro-Leão R. Morais J. Pinheiro A. Vieira Lopes P. Bettencourt |
| author_sort | P. Pinto-Lopes |
| collection | DOAJ |
| description | Polymyositis is an idiopathic inflammatory myopathy, characterized by proximal muscle weakness and sometimes extramuscular manifestations. We report the case of a 51-year-old male, with history of complete heart block, which required pacemaker implantation, and subsequently heart failure, presenting to the emergency department with worsening of dyspnea and peripheral edema. He was admitted to the Internal Medicine ward with acute heart failure and started on diuretic therapy. During hospitalization, he was discovered to have marked rhabdomyolysis. Examination revealed proximal symmetrical muscle weakness and arthralgia. The immunological study, electromyography and muscle biopsy confirmed polymyositis. The patient was started on prednisolone with clinical improvement and resolution of rhabdomyolysis. The presence of conduction defect, ventricular dysfunction, mitral valve regurgitation, segmental hypokinesia (myocardial scintigraphy without perfusion defects) and pulmonary hypertension, as well as elevated troponin with improvement after specific therapy, points to cardiac involvement. Polymyositis is a rare entity, with an insidious evolution and a myriad of extramuscular features that can mimic other conditions. In particular, cardiac involvement may be the first and only recognized manifestation. The key point for the diagnosis is to contemplate the possibility of polymyositis. |
| first_indexed | 2024-12-11T10:27:28Z |
| format | Article |
| id | doaj.art-ed7e056a65fb4463a169cfb296918aea |
| institution | Directory Open Access Journal |
| issn | 0048-7449 2240-2683 |
| language | English |
| last_indexed | 2024-12-11T10:27:28Z |
| publishDate | 2017-08-01 |
| publisher | PAGEPress Publications |
| record_format | Article |
| series | Reumatismo |
| spelling | doaj.art-ed7e056a65fb4463a169cfb296918aea2022-12-22T01:11:06ZengPAGEPress PublicationsReumatismo0048-74492240-26832017-08-01692788310.4081/reumatismo.2017.924743Acute heart failure and rhabdomyolysis: a clue for the diagnosis of polymyositis with cardiac involvementP. Pinto-Lopes0L. Carneiro-Leão1R. Morais2J. Pinheiro3A. Vieira Lopes4P. Bettencourt5Department of Internal Medicine, Centro Hospitalar São João, PortoDepartment of Internal Medicine, Centro Hospitalar São João, PortoDepartment of Internal Medicine, Centro Hospitalar São João, PortoDepartment of Pathology, Centro Hospitalar São João, PortoDepartment of Internal Medicine, Centro Hospitalar São João, PortoDepartment of Internal Medicine, Centro Hospitalar São João, PortoPolymyositis is an idiopathic inflammatory myopathy, characterized by proximal muscle weakness and sometimes extramuscular manifestations. We report the case of a 51-year-old male, with history of complete heart block, which required pacemaker implantation, and subsequently heart failure, presenting to the emergency department with worsening of dyspnea and peripheral edema. He was admitted to the Internal Medicine ward with acute heart failure and started on diuretic therapy. During hospitalization, he was discovered to have marked rhabdomyolysis. Examination revealed proximal symmetrical muscle weakness and arthralgia. The immunological study, electromyography and muscle biopsy confirmed polymyositis. The patient was started on prednisolone with clinical improvement and resolution of rhabdomyolysis. The presence of conduction defect, ventricular dysfunction, mitral valve regurgitation, segmental hypokinesia (myocardial scintigraphy without perfusion defects) and pulmonary hypertension, as well as elevated troponin with improvement after specific therapy, points to cardiac involvement. Polymyositis is a rare entity, with an insidious evolution and a myriad of extramuscular features that can mimic other conditions. In particular, cardiac involvement may be the first and only recognized manifestation. The key point for the diagnosis is to contemplate the possibility of polymyositis.http://www.reumatismo.org/index.php/reuma/article/view/924Inflammatory myopathiesPolymyositisRhabdomyolysisHeart involvementAcute heart failure. |
| spellingShingle | P. Pinto-Lopes L. Carneiro-Leão R. Morais J. Pinheiro A. Vieira Lopes P. Bettencourt Acute heart failure and rhabdomyolysis: a clue for the diagnosis of polymyositis with cardiac involvement Reumatismo Inflammatory myopathies Polymyositis Rhabdomyolysis Heart involvement Acute heart failure. |
| title | Acute heart failure and rhabdomyolysis: a clue for the diagnosis of polymyositis with cardiac involvement |
| title_full | Acute heart failure and rhabdomyolysis: a clue for the diagnosis of polymyositis with cardiac involvement |
| title_fullStr | Acute heart failure and rhabdomyolysis: a clue for the diagnosis of polymyositis with cardiac involvement |
| title_full_unstemmed | Acute heart failure and rhabdomyolysis: a clue for the diagnosis of polymyositis with cardiac involvement |
| title_short | Acute heart failure and rhabdomyolysis: a clue for the diagnosis of polymyositis with cardiac involvement |
| title_sort | acute heart failure and rhabdomyolysis a clue for the diagnosis of polymyositis with cardiac involvement |
| topic | Inflammatory myopathies Polymyositis Rhabdomyolysis Heart involvement Acute heart failure. |
| url | http://www.reumatismo.org/index.php/reuma/article/view/924 |
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