Acute myocarditis with atrial fibrillation and antiphospholipid syndrome as a substrate for cardioembolic stroke. Case presentation

Abstract

Abstract

Acute myocarditis is an inflammatory disease of the myocardium that can progress to ventricular dysfunction, arrhythmias, and thromboembolic events. The coexistence of atrial fibrillation and secondary thrombophilia significantly increases the risk of cardioembolic stroke, especially in young patients with cardiometabolic risk factors. To describe the clinical, evolutionary, and therapeutic characteristics of a patient with acute myocarditis associated with secondary thrombophilia due to antiphospholipid syndrome and cardioembolic ischemic cerebrovascular event, we present the case of a 29-year-old male patient with a history of acute respiratory infection, newly diagnosed arterial hypertension, obesity, dyslipidemia, and hyperuricemia. He presented with exertional dyspnea, fatigue, palpitations, and precordial pain. Physical examination revealed irregular tachyarrhythmia, signs of systemic congestion, and right-sided hemiplegic neurological deficit. The echocardiogram showed left ventricular dilation, global hypokinesia, and systolic dysfunction. The electrocardiogram revealed paroxysmal atrial fibrillation, while brain computed tomography confirmed cardioembolic ischemic infarction. Thrombophilia testing revealed platelet hyperaggregability and positive lupus anticoagulant, consistent with secondary thrombophilia due to antiphospholipid syndrome. Comprehensive treatment was initiated with a beta-blocker, a renin-angiotensin-aldosterone system antagonist, diuretics, a statin, and oral anticoagulation. At six months, the patient showed complete clinical recovery and normalization of ventricular systolic function (LVEF 57%), with total resolution of the neurological deficit. The combination of acute myocardial inflammation, atrial arrhythmia, and primary thrombophilia can trigger cardioembolic stroke even in young patients with prothrombotic states and high cardiometabolic risk. Early diagnosis and the implementation of comprehensive treatment allow for the reversibility of myocardial and neurological damage, improving functional prognosis.