RESUMO
Myocarditis due to Graves` disease is rare and has a clinical presentation that mimics acute coronary syndrome. In this case report, a 50-year-old woman was admitted with a clinical presentation of very high-risk non-ST segment elevation myocardial infarction, new-onset atrial fibrillation, and acute heart failure. Normal coronary angiography and the presence of intra-myocardial late gadolinium enhancement based on cardiac MRI led to the diagnosis of myocarditis. The presence of thyroid nodules and elevated thyrotropin receptor antibodies indicated Graves` disease as the underlying cause of myocarditis. Management using Propylthiouracil and the guideline-directed medical therapy for heart failure successfully improved the patient's condition. Early diagnosis, effective care, and adequate knowledge of the relationship between hyperthyroidism and myocarditis, improve outcomes in Graves' disease-induced myocarditis.
RESUMO
Mitral facies is a classical feature of chronic mitral stenosis (MS) that commonly associated with low cardiac output and pulmonary hypertension. A 44-year-old woman presented with 10-year history of refractory right heart failure. We noted distinctive malar rash appearance on her face known as "mitral facies." An echocardiogram revealed severe MS and other significant valve involvement with typical characteristics of rheumatic valvular heart disease. Doppler measurement showed decreased cardiac output and severe pulmonary hypertension in this patient. The mitral facies could be an alarming sign of a more severe and advanced form of MS. It also can be a marker of impaired cardiac output and concomitant severe pulmonary hypertension.
