Acute heart failure and rhabdomyolysis: a clue for the diagnosis of polymyositis with cardiac involvement

Submitted: 27 September 2016
Accepted: 27 April 2017
Published: 3 August 2017
Abstract Views: 1698
PDF: 847
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

Polymyositis is an idiopathic inflammatory myopathy, characterized by proximal muscle weakness and sometimes extramuscular manifestations. We report the case of a 51-year-old male, with history of complete heart block, which required pacemaker implantation, and subsequently heart failure, presenting to the emergency department with worsening of dyspnea and peripheral edema. He was admitted to the Internal Medicine ward with acute heart failure and started on diuretic therapy. During hospitalization, he was discovered to have marked rhabdomyolysis. Examination revealed proximal symmetrical muscle weakness and arthralgia. The immunological study, electromyography and muscle biopsy confirmed polymyositis. The patient was started on prednisolone with clinical improvement and resolution of rhabdomyolysis. The presence of conduction defect, ventricular dysfunction, mitral valve regurgitation, segmental hypokinesia (myocardial scintigraphy without perfusion defects) and pulmonary hypertension, as well as elevated troponin with improvement after specific therapy, points to cardiac involvement. Polymyositis is a rare entity, with an insidious evolution and a myriad of extramuscular features that can mimic other conditions. In particular, cardiac involvement may be the first and only recognized manifestation. The key point for the diagnosis is to contemplate the possibility of polymyositis.

Dimensions

Altmetric

PlumX Metrics

Downloads

Download data is not yet available.

Citations

How to Cite

Pinto-Lopes, P., Carneiro-Leão, L., Morais, R., Pinheiro, J., Vieira Lopes, A., & Bettencourt, P. (2017). Acute heart failure and rhabdomyolysis: a clue for the diagnosis of polymyositis with cardiac involvement. Reumatismo, 69(2), 78–83. https://doi.org/10.4081/reumatismo.2017.924