title: A 56-year-old woman with breathlessness.
abstract: A 56-year-old female with adult-onset asthma was admitted to the cardiology service with intermittent left-sided chest pain and progressive dyspnoea. Twelve months prior to this admission, she had received a course of prednisolone for bilateral anterior uveitis. Physical examination was unremarkable with blood sampling revealing a marked eosinophilia (eosinophil count 17.3×109/L) and a perinuclear antineutrophil cytoplasmic antibody staining pattern on indirect immunofluorescence microscopy (myeloperoxidase antibodies 83 IU/mL). ECG demonstrated anterolateral T-wave inversion (see online supplementary figure S1). High-sensitivity troponin T was elevated at 100 ng/L. Invasive coronary angiography showed unobstructed coronary arteries. Echocardiography and cardiac magnetic resonance (CMR) were performed (figure 1).
  
  
  
  What is the most appropriate therapy? Beta-blockade and ACE inhibitionMethylprednisoloneIntravenous antibioticsEndocardiectomyImplantable cardioverter defibrillator (ICD).
authors.affiliation: Centre for Cardiovascular Science, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: Alastair J
authors.initials: AJ
authors.lastname: Moss
authors.affiliation: Centre for Cardiovascular Science, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: Marc R
authors.initials: MR
authors.lastname: Dweck
authors.affiliation: Dorset Heart Centre, Royal Bournemouth Hospital, Bournemouth, UK.
authors.forename: Peter D
authors.initials: PD
authors.lastname: O'Kane
mesh_terms: D015267:Churg-Strauss Syndrome / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology; D004417:Dyspnea / Q000209:etiology*; D004452:Echocardiography; D004802:Eosinophilia / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology* / Q000276:immunology; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008279:Magnetic Resonance Imaging; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D009205:Myocarditis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology* / Q000276:immunology
chemical_list: D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D008775:Methylprednisolone