Excerpt

A 34-year-old Caucasian male physician was admitted in June 2008 to our emergency department with complaints of palpitations. The symptoms had appeared the day before. The patient had had an ECG recorded at a peripheral hospital, showing monomorphic ventricular extrasystole and trigeminism (Fig. 1a); markers of cardiac necrosis were negative. Episodes of mild cough, that lasted 4–5 days, and sporadic palpitations, had been present in the last 3 weeks, although these symptoms did not limit normal life and physical activities. He had a history of mildly elevated liver enzymes, was a former smoker, and had a positive family history of cardiovascular disease. Physical examination was absolutely negative except for the presence of swollen lymph nodes in neck and inguinal region. Laboratory showed elevated markers of liver function (GPT-ALT:69U/l, GOT-AST:41U/l, gamma-GT:227U/l) and C-reactive-protein (7.8 mg/dl, reference <5 mg/dl). ECG showed negative T-waves in leads DII, DIII and aVF (Fig. 1b). Transthoracic echocardiography showed normal size and function of all heart chambers, no valvular disease, and no pericardial effusion. The patient was admitted for further workout.

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