31 August 2022: Articles
Posterior Myocardial Infarction in a 45-Year-Old Javanese Woman with a 1-Month History of COVID-19-Related Guillain-Barré Syndrome: A Challenging Emergency Diagnosis
Challenging differential diagnosis
Ivan Satria Pratama B , Yudi Her Oktaviono A , Terrence Timothy Evan Lusida A*DOI: 10.12659/AJCR.937105
Am J Case Rep 2022; 23:e937105
Table 1. Comparison of this case with other case reports describing acute coronary syndrome in GBS patients.
| Author | Patient | Symptoms and timing | ECG changes | Cardiac markers | Imaging | Intervention | Final cardiac diagnosis | Outcome |
|---|---|---|---|---|---|---|---|---|
| This case | 45-year-old woman | Leg, abdomen, and chest pain 1 month after GBS diagnosis | ST segment depression V1-V4, ST elevation on posterior leads | Elevated troponin I level | Total occlusion of D1 branch of LAD | Stenting of D1 branch of LAD | Posterior STEMI | The patient survived |
| Harada []14 | 44-year-old woman | Chest pain on day 5 of GBS diagnosis | transient T wave inversion in II, III, aVF, and V2 through V5 | Normal | Echocar-diogram showed no regional wall motion abnormality. Coronary angiography with ergonovine test were normal | IVIG for GBS, nitroglycerine and diltiazem for cardiac symptoms | GBS-associated T wave changes | The patient survived |
| Cao et al []7 | 37-year-old woman | Pantalgia (generalized pain) 2 months after GBS diagnosis | Transitional T wave changes in I, AVL, and V2 through V4 | Normal | CT coronary angiography showed critical stenosis in LAD. Echocar-diogram was normal | Patient refused initial intervention. Revascula-rization was done at the 2-week follow-up | Non-ST segment elevated ACS | Non-ST segment elevated ACS on 2-week follow-up |
| Kuruppuarachchi et al []21 | 56-year-old man | Chest pain as the initial presentation of autonomic variant of GBS | Total atrioven-tricular block | Normal | Echocar-diogram was normal, no coronary angiography | IVIG | Autonomic variant of GBS | The heart block reverted to sinus. rhythm. The patient survived |
| Jones et al []19 | 41-year-old woman | Chest pain on the ninth day of GBS symptoms onset | ST segment elevation in leads V2-4 and ST depression in leads I and aVL | No data | Coronary angiography showed mild-moderate non-obstructive atheroma in the LAD. Ventricu-lography showed severe apical hypokinesia and ballooning | IVIG for GBS; beta blocker and ACE inhibitor | Takotsubo cardiomyo-pathy | The patient survived |
| GBS – Guillain-Barré-Syndrome; IVIG – intravenous immunoglobulin; LAD – left anterior descending artery; STEMI – ST elevation myocardial infarction. | ||||||||