title: Chest pain and palpitations: taking a closer look.
abstract: This case highlights the importance of considering a wide differential diagnosis in a young patient with chest pain and an abnormal ECG. Rarer causes of myocarditis such as GCM should be sought in patients who develop ventricular arrhythmias or high-grade heart block because the treatment is different and dramatically influences outcome. Our patient is the first reported case of GCM and a concurrent diagnosis of tuberculosis. It is most likely that the histological appearance of GCM was due to the presence of mycobacterial infection within the myocardium, and we believe that effective antituberculous therapy has led to resolution of the GCM without the need for continued long-term immunosuppression.
authors.affiliation: Royal Free Hospital, London, UK.
authors.forename: Russell J
authors.initials: RJ
authors.lastname: Everett
authors.forename: Mary N
authors.initials: MN
authors.lastname: Sheppard
authors.forename: David C
authors.initials: DC
authors.lastname: Lefroy
mesh_terms: D000328:Adult; D001706:Biopsy; D002637:Chest Pain / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D017147:Defibrillators, Implantable; D003937:Diagnosis, Differential; D004562:Electrocardiography / Q000379:methods*; D015726:Giant Cells / Q000473:pathology; D006801:Humans; D008297:Male; D009205:Myocarditis / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D009206:Myocardium / Q000473:pathology; D017180:Tachycardia, Ventricular / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology
keywords: arrhythmia, cardiac; defibrillator, implantable; electrophysiology; heart failure; myocarditis; tachycardia; tuberculosis; ventricular