title: Diagnostic dilemmas in cardiology.
abstract: A 29-year-old pregnant woman presented in accident and emergency with severe acute left ventricular failure requiring admission to the intensive care unit. A nasal swab was found to be positive for H1N1 making peripartum and viral cardiomyopathies, the most likely differential diagnoses. CT coronary angiography and subsequent invasive angiography revealed an anomalous coronary system thus making ischaemic cardiomyopathy also a possibility. Cardiac MRI played a vital role in identifying the underlying cause, which in this case was that of H1N1 influenza cardiomyopathy. Correct diagnosis in such patients is paramount as this impinges on patients' overall prognosis. In this case aggressive initial therapy including inotropic support and invasive ventilation followed by standard antifailure treatment with β-blockers and angiotensin-converting enzyme inhibitors led to restoration of the patient's left ventricular function and an associated marked improvement in symptoms.
authors.affiliation: Cardiology Department, Lister Hospital, Stevenage, UK.
authors.forename: Charis
authors.initials: C
authors.lastname: Costopoulos
authors.forename: Adam
authors.initials: A
authors.lastname: Benson
authors.forename: Sanjay
authors.initials: S
authors.lastname: Prasad
authors.forename: Azad
authors.initials: A
authors.lastname: Ghuran
mesh_terms: D000328:Adult; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002311:Cardiomyopathy, Dilated / Q000175:diagnosis* / Q000503:physiopathology / Q000821:virology; D002585:Cesarean Section; D017023:Coronary Angiography; D003422:Critical Care; D003937:Diagnosis, Differential; D004635:Emergency Medicine; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000503:physiopathology / Q000821:virology; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype / Q000302:isolation & purification*; D007251:Influenza, Human / Q000150:complications / Q000175:diagnosis*; D017202:Myocardial Ischemia / Q000175:diagnosis; D011247:Pregnancy; D011379:Prognosis; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis* / Q000503:physiopathology / Q000821:virology
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors